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RESEARCHES ON EPILEPSY:

ITS ARTIFICIAL PRODUCTION IN ANIMALS, AND ITS ETIOLOGY,
NATURE AND TREATMENT IN MAN.

FIRST PART OF A NEW SERIES

EXPERIMEINTAL AND CLINICAL RESEARCHES

APPLIED TO

PHYSIOLOGY AND PATHOLOGY.

BY E. BROWN SEQUARD, M. D.,

Professor of Physiolopy at the Cooper Institute, N. Y. ; Laureate of the Acadimie des Sciences of France ;
Ex-Secretary and Vice-President of the Society de Biologic ; Bx-Secretai y of the SociUi Phi-
lomathique of Paris ; Member of the American Philosophical Society of Philadelphia, &c.

Re-published from the Boston Medical and Surgical Journal, from Nov. 1856, to Nov. 1857.

BOSTON:
PRINTED BY DAVID CLAPP.
1S57.

Entered, according to Act of Congress, in the year 1857, by
Edward Brown Sequard,
the Clerk's Office of the District Coui-t of the District of Massachusetts.

EXPERIMENTAL AND CLINICAL RE8EA11CHES

APPLIED TO

PHYSIOLOGY AND PATHOLOGY.

From August, 1852, lo August, 1853, I published in ihe Medical
Examiner., of Philadelphia, a series of ihirty-three short papers,
which Avere aflervvards connected in one volume, under the lille :
^^Experimental Researches applied to Physiology and Paihology.'''
The following article is the first of a second series of papers, which,
with the preceding series which has appeared in Philadelphia, will
form a complete summary of all my original researches in various
branches of the medical sciences.

I. Artificial Production of an Epileptiform Affection in
Animals, and ETioLocr and Treatment of certain forms of Epi-
lepsy in Man.

Six years ago, I discovered that certain alterations of the spinal
cord, upon mammals, produce, after a few weeks, a convulsive
affection, resembling epilepsy. (See Comptes Rendus de la Soc.
de Biol., \. ii., pp. 105 and 169 — 1850.) Since that lime, I have
found many new facts concerning this affection ; and lately, in
comparing the results of my experiments with what has been ob-
served in man, in many cases of epilepsy, I have been led to some
conclusions, which are, I think, very imporlani, as regards the eti-
ology, the nature and the treatment of epilepsy. Although some
of the results of my experiments have already been published (see
my Exper. Researches applied to Physiology and Pathology, pp. 36
and 80, the Archives de Medec, etc., Fe vrier, 1856 ; and the Moni-
teur des Hopilaiix, Oct., 1856, p. 954), I will relate th em here, as I
shall have to make use of them when I expose my views upon the

pathology and treatment of epilepsy. I will also give a detailed
account of some of the facts 1 have observed in animals, because
these facts throw a great deal of light upon the phenomena of
epilepsy in man.

§1. I have found that the following kinds of injury to the spinal
cord are able to produce epilepsy, or at least a disease resembling
epilepsy, in animals belonging to different species, but mostly upon
guinea-pigs.

1st. A complete transversal section of a lateral' half of this
organ.

2d. A transversal section of its two posterior columns, of its
posterior cornua of gray matter, and of a part of the lateral
columns.

3d. A transversal section of either the posterior columns or the
lateral, or the anterior alone.

4th. A complete transversal section of the whole organ.
5th. A simple puncture.

Of all these injuries, the first, the second and the fourth seem to
have more power to produce epilepsy than the others. The first
particularly, i. e., the section of a lateral half of the spinal cord,
seems to produce constantly this disease in animals that live longer
than three or four weeks after the operation. After a section of
either the lateral, the anterior or the posterior columns alone, epi-
lepsy rarely appears, and it seems that in the cases where it has
been produced, there has been a deeper incision than usual, and
that part of the gray matter has been attained. In other experi-
ments, fcAV in number, the section of the central gray matter (the
white being hardly injured) has been followed by this convulsive
disease. I have seen it but very rarely after a simple puncture of
the cord.

It is particularly after injuries to the part of the spinal cord which
extends from the seventh or eighth dorsal vertebra to the third lum-
bar, that epilepsy appears.

>§> II. Usually this affection begins during the third or fourth
week after the injury. In some cases I have seen it beginning dur-
ing the second week, and even one or two days before. At first
the fit consists only in a spasm of the muscles of the face and neck,
either on one or the two sides, according to the transversal extent of
the injury. One eye or both are forcibly shut, the head is drawn

towards one of the shoulders, and the niouth opened by the spasm
of some of the muscles of the neck. This spasmodic attack quick-
ly disappears.

After a few days the fit is more complete, and all parts of the
body, which are not paralyzed, have convulsions. According to
the seat of the injury, the parts that have convulsions greatly vary.
When the lesion is near the last dorsal vertebrae or the first lumbar,
and consisting of a section of a lateral half of the spinal cord, con-
vulsions take place everywhere, except only the posterior limb on
the side of the injury. If the lesion consists of the section of the
two posterior columns and a part of the lateral columns, and of
the gray matter, convulsions take place everywhere without excep-
tion, but with much more violence in the anterior parts of the
body. When the lesion exists at the level of the last dorsal ver-
tebrae and consists in a transversal section of the two anterior or of
the two lateral columns, convulsions are ordinarily limited to the an-
terior parts of the body ; but it is a very interesting fact that they
are not always confined to these parts, the two posterior limbs hav-
ing sometimes very strong tetanic spasms, at the same time that
there are clonic convulsions in the anterior limbs. After a trans-
versal section of the central gray matter, or of the Avhole spinal
cord, in the dorsal region, convulsions are limited to either the an-
terior or the posterior parts of the body.

<§) III. Convulsions may come either spontaneously, or after cer-
tain excitations. The most interesting fact concerning these fits is
that il is possible, and even very easy, to produce them by two
modes of irritation. If we take two guinea pigs, one not having
been submitted to any injury of the spinal cord, and the other hav-
ing had this organ injured, we find, in preventing them from breath-
ing for two minutes, that convulsions come in both ; but if we
allow them to breathe again, the first one recovers almost at once,
while the second continues to have violent convulsions for two or
three minutes and sometimes more. There is another mode of
giving fits to the animals which have had an injury to the spinal cord.
Pinching of the skin in certain parts of the face and neck is always
followed by a fit. If the injury to the spinal cord consists only in
a transversal section of a lateral half, the side of the face and neck
which, when irritated, may produce the fit, is on the side of the inju-
ry ; i. e., if the lesion is on the right side of the cord, it is the right
side of the face and neck which are able to cause convulsions, and

vice versa. If the two sides ol' the et)rd have betMi injured, ilje two
sides of the face and neck have the faculty of producing fits, when
they are irritated. No other part of the body but a portion of the
face and neck has this faculty. In the face, the parts of the skin
animated by the ophthalmic nerve cannot cause the fits ; and of the
two other branches of the trigeminal nerve, only a few filaments
have the property of producing convulsions. Among these fila-
ments, the most powerful, in this respect, seem to be some of those
of the suborbitary and of the aurioulo-temporalis. A few filaments
of the second, and perhaps of the third cervical nerves, have also
this property of producing fits. In the face, the following parts
may be irritated without inducing a fit : the nostrils, the lips, the
ears, and the skin of the forehead and that of the head. In the
neck, there is the same negative result when an irritation is brought
upon the parts in the neighborhood of the median line, either in
front or behind. On the contrary, a fit always follows an irritation
of some violence when it is made in any part of a zone limited by
the four following lines : one uniting the ear to the eye ; a second
from the eye to the middle of the length of the inferior maxillary
bone ; a third which unites the inferior extremity of the second line
to the angle of the inferior jaw ; and a fourth which forms half a cir-
cle, and goes from this angle to the ear, and the convexity of which
approaches the shoulder.

<§. IV. Can we attribute to the great degree of sensibility of the
face and of the neck the property exclusively possessed by these
parts to produce fits in animals which have had their spinal cord in-
jured ? In other words, is it in consequence of the pain felt, that
there are fits in these circumstances ? This explanation is quite in
opposition with the following facts. 1st. When the injury exists
only in one of the lateral halves of the cord, the face and neck on
the other side have not the power of producing fits, whatever is the
degree of the irritation upon them. 2d. In the same case, the poste-
rior limb on the side where the cord is injured, is in a state of hy-
perseslhesia, and, nevertheless, the most violent irritations upon this
limb do not produce fits. 3d. It is sometimes suflicient to touch the
face or the neck, or even to blow upon them, to produce the fits.
Therefore, unless we admit that there is an extraordinary degree
of hypersesthesia in the parts which possess the faculty of produc-
ing the convulsions when they are irritated, we must admit that it is
not the pain Avhich causes these convulsions. There does not seem

to be more sensibility in these parts than in other parts of the body.
When a fit, or rather a series of fits, have taken place, and when,
conscqnonily, the power of having them is much diminished, it is
easy to ascertain that these parts seem not to be more sensitive than
others. The animal does not cry more when they are pinched or
galvanized, than Avhen other parts are irritated in the same way.

The production of fits by the irritation of certain parts of the neck
and face, seems to belong to reflex actions. It is well known that an
irritation of the skin and of the mucous membranes may easily pro-
duce certain reflex movements, which very rarely take place after an
irritation of the trunks of thesensitive nerves. For instance, coughing
is almost a constant result of an irritation of the mucous membrane of
the larynx and of the bronchial tubes, while it is very rarely produced
by an irritation of the trunk of the par vagum. Something similar
exists for the production of convulsive fits when the face is irritated
in animals upon which the spinal cord has been injured. If we lay
bare the nerves of the face and neck of these animals, we find that
even the greatest irritations upon them do not produce a fit. Be-
sides, if vv^e dissect a large piece of the skin of the face, so as to
let it be in connection with the nervous centres only by the suborbi-
tory nerve, we find that the irritation of this piece of skin is still
able to produce convulsions, while the irritation of the very nerve
which connects it with the brain does not produce any. It seems,
therefore, that it is in the cutaneous ramifications of certain nerves
of the face and neck that resides the faculty of producing convul-
sions in the animals upon which I have injured the spinal cord.
There is, in that case, as 1 will show hereafter, something resem-
bling what lakes place in man in cases where a ligature around a
limb is sufficient to prevent a fit of epilepsy.

<§i V. What is the nature of the fits that we find in animals upon
which the spinal cord has been injured ? I think these fits ought to
be considered as epileptic. The following description of these con-
vulsions will show that, if they are not positively epileptic, they are
at least epileptiform. When the attack begins, the head is drawn
first, and sometimes violently, towards the shoulder, by the contrac-
tion of the muscles of the neck, on the side of the irritation ; the
mouth is drawn open by the contraction of the muscles of the neck,
which are inserted upon the lower jaw, and the muscles of the face
and eye (particularly the orbicularis) contract violently. All these
contractions usually occur simultaneously. Frequently at the same

lime, or very nearly so, the animal suddenly cries with a peculiar
hoarse voice, as if the passage of air were not free through the vo-
cal chords, spasmodically contracted. Then the animal falls, some-
limes on the irritated side, sometimes on the other, and then, all the
muscles of the trunk and limbs that are not paralyzed become the
seat of convulsions, alternately clonic and tonic. The head is al-
ternately drawn upon one or the other side. All the muscles of the
neck, eyes and tongue contract alternately. In the limbs, when the
convulsions are clonic, there are alternative contractions in the
flexor and the extensor muscles. Respiration takes place irregu-
larly, on account of the convulsions of the respiratory muscles.
Almost always there is an expulsion of fsecal matters, and often of
urine. Sometimes there is erection of the penis, and even ejacu-
lation of semen.

These are the features which render these fits very much like
epilepsy. But they seem to differ from this disease, by the three
following characters : 1st. The animals sometimes cry during the
fits, when they are irritated, and it seems, therefore, that they have
not lost their sensibility. Now as the loss of sensibility is consider-
ed a symptom essential to epilepsy, it appears that we ought not
to consider as epileptic the convulsions existing in these animals.
But, we cannot admit this as a decisive objection, when we remark
that frequently they seem to be deprived of sensibility, and that,
in man, during true fits of epilepsy, there are sometimes periods
wheresensibility is notlost. 2d. These animals usually have no foam
at the mouth, and this symptom has been considered by many writers
as essential to epilepsy ; but there can be no doubt that there are cases
of epilepsy without any foam. Besides, we may easily understand
why there is no foam ordinarily in animals : usually their fits do not
last long enough. 3d. The fits in these animals are most frequently
a series of fits lasting two or three minutes, and separated one from
the other by a period of one or two minutes, during which the ani-
mals are able to rise and to stand on their feet. In this respect
these animals differ from the majority of epileptic men, who have
not a recurrence of fits after so short a period of calm ; but there are
cases of rapidly-recurring fits in man, and therefore we cannot de-
ny that the fits of these animals are true epileptic fits, on the ground
that they have that peculiar character of rapid recurrence.

The apparent differences between the fits in animals which have
had the spinal cord injured, and true epilepsy in man, ought not,
therefore, to prevent our considering them as epileptic fits. Not

only the convulsions resemble ihose of true epilepsy, but the fils are
not mere accidents, and they come by series of two or three, once a
week, once a day, or even ten or twenty times a day, and the dis-
ease lasts for years. Besides, we find, after long and violent fits, that
these animals are, for a time, in a state of drowsiness, like men after
epileptic convulsions. It seems rational to conclude, from this dis-
cussion, that if the convulsions of these animals are not truly epi-
leptic, they are at least epileptiform.

<§^ VI. The facts expressed in the preceding parts of this paper
lead to many interesting conclusions. First, they give a positive
proof that an injury to the spinal cord may be the cause of an epi-
leptiform affection. Secondly, they show a wonderful relation be-
tween certain parts of the spinal cord and certain branches of some
of the nerves of the face and neck. Thirdly, they show that epi-
leptiform convulsions may be the constant consequence of slight
irritations upon certain nerves. Fourlhly, they show that even
when an epileptiform qffectipn has its primitive cause in the nervous
centres, some cutaneous ramifications of nerves, not directly con-
nected Avith the injured parts of these centres, have a power of pro-
ducing convulsions, which other nerves, even directly connected with
them, have noi. Fifthly, they show that the cutaneous ramifi-
cations of certain nerves may have the power of producing convul-
sions, while the trunks of these nerves have not this power.

<§> VII. The constant appearance of a disease very much resem-
bling epilepsy, after certain injuries to the spinal cord, in animals,
will perhaps settle the undecided question whether epilepsy, in man,
may originate from an alteration of the spinal cord or not. It
seems very strange that physicians have been so unwilling to admit
that the spinal cord could be the seat of the primitive cause of epi-
lepsy, when they admit that any nerve or any part of the encepha-
lon, being altered, may produce epilepsy. The seat of this disease
seems to be together in the . part of the brain where resides the facul-
ties of Perception and of Volition, and in the part of the cere-
bro-spinal axis endowed with the reflex faculty ; but, whatever may
be thought on this subject, it seems quite certain, from facts observ-
ed in man and in animals, that epilepsy may be produced by vari-
ous kinds of alterations of the encephalon, of the spinal cord and
of a great many nerves. In other words, the peculiar disturbance
of the cerebro-spinal axis which constitutes epilepsy, may be gene-
2

rated by alterations of various parts of this nervous axis and by
many iierves. This view does not agree with thai of the most dis-
tinguished among the recent writers upon epilepsy. They have
hardly spoken of the influence of the alterations of the spinal cord
upon the production of epilepsy. For instance, JVI. Delasiauve
(TraiU de I'Epilepsie, 1854, pp. 174-181) does not speak at all of
this influence, and we find that he places a case of epilepsy with
an hypertrophy of the spinal cord among many other cases forming
a series of doubtful or equivocal alterations. Hasse does not pay
more attention than Delasiauve to the share of the spinal cord in
the causation of epilepsy. He seems to take notice only of the in-
fluence of the alterations of the encephalon. {Krankheiten des Ner-
venapparates, 1S55, pp. 266-67.) Romberg (Lehrbuch der Nerven-
krankheiien des Mensc/ien, 3d edition, 1855, vol. i. part 2, p. 686)
has written only a few lines on the relations between alterations of
the spinal cord and epilepsy. He thinks that some of the facts re-
lated by Ollivier d'Angers prove the existence of these relations.

M. Bouchet, who had, in a paper with M. Cazauvielh (^Archives
de Medec, etc., 1825, t. ix.), mentioned some cases of diseases of
the spinal cord with epilepsy, has tried to show in a recent paper
(Annales Medico-PsychoL, 185.3) that epilepsy is usually connected
with alterations of the hippocampus major (cornu amnionis).

If we take notice of this fact that the spinal cord is very rarely
examined, we understand that although the number of cases on
record, as far as I know, of alterations of this organ in epilepsy,
amounts only to about fifty, there is an immense number of cases
in which after death from the so-called idiopathic epilepsy, the brain
was examined, but not the spinal cord. In these cases, particularly
where nothing was found in the brain, able to account for the dis-
ease, it should have been of the greatest importance to examine the
spinal cord. Such a neglect is a great fault, particularly since the
publication made by Esquirol on the result of his autopsies. In the
corpses of ten epileptics, Esquirol (TraiU des Maladies Me.niales,
1838, vol. i., p. 311) found, nine times, various alterations of the
spinal cord or of its membranes. In four cases, the spinal cord
was softened, particularly in the lumbar region ; nine times there
were lenticular concretions in the arachnoid, some of which were
cartilaginous, some osseous ; once there were a great many hyda-
tids in the cavity of the arachnoid.

Mitivie, quoted by Esquirol (loc cii., p. 311), found concretions
jn the arachnoid in two children who died from epilepsy.

Two cases of chronic meningitis with epilepsy, have been record-
ed by M. Clot. (Rech. and Observ. sur le SpinUis, 1820.) One
case of this kind is related by Ollivier d'Angers (TraiU des Mala-
dies de la Moelle Spini^re, 3eme edil., 1837, vol. ii., p. 319).

CoXmeW (De Vepil. sous le rapport de son siege, 1824) speaks of
four epileptics, in two of whom the spinal arachnoid contained
many cartilaginous plates, while in the two others the density of the
spinal cord was considerably increased.

Bouchet and Cazauvielh have found, in many cases, circumscrib-
ed softenings of the spinal cord, and other alterations of this organ
and its sheath.

Forget, quoted by Ollivier d'Angers (loc. cil., vol. ii., p. 571),
has seen two very important cases, which have a great analogy with
what I have found in animals.

Gendrin, quoted by Ollivier (vol. ii., pp. 502 and 520), has found
in two epileptics a tubercle in the cervical region of the spinal cord*

Barthez and Rilliet {Traite des Maladies des Enfants, 2d edit.,
1854, vol. iii., p. 589) relate a very curious case in which epilepsy
existed in a girl, who had an angular curvature of the spine in the
dorsal region. The symptoms were very much the same as those
existing in my animals, and, as it is in them, there was no foam at
the mouth. There was no alteration in the nervous centres, except
in the dorsal region of the spinal cord, which was almost liquefied.
This softening occupied the whole of the cord transversely, and
was about one centimetre long.

I might add many other cases of alteration of the spinal cord in
epileptics, recorded by writers of the previous centuries, such as
Bouet, Lieulaud, Morgagni, Musel, &c. In the Avork of Portal
(Observ. sur la Nal. et le Traiiemeni de VEpil., 1827, p. 28) there is
a curious case of epilepsy with- a dilatation of the central canal of the
spinal cord, which was filled with water.

If epilepsy has truly been the result of an alteration of the spinal
cord in all or in some of the above cases, it might be asked why
there are so many cases of diseases or injuries of the spinal cord
without epilepsy. This objection loses its value when we remark
that every day there are casesof tumors and various alterations of the
brain Avithout epilepsy, and that, nevertheless, no one doubts that
this disease is sometimes produced by such lesions. Besides, I
have found that certain kinds of injury to the spinal cord, in ani-
mals, produce much more frequently than others an epileptiform

affection, and there is only one kind of injury which seems to pro-
duce it constantly. This injury consists in a section of the whole
of a lateral hjflf of the spinal cord. I do not know of a single
case, in man, where life has been saved after such an injury had been
done to the spinal cord. In some cases, where, probably, a great
part of the lateral half of this organ had been divided transversely,
there has been no epilepsy. Such a case is recorded by Morgagni
(De sed. 8f causis morborum, ep. 53, <§; 23) ; another by Boyer
(Traitedes Maladies Chirurg., lere edit., vol. vii., p. 9), and a third
by my friend, M. Vigues (Moniteur des Hopilaux, 18o5, p. 838).
In animals, after an incomplete transversal section of a lateral half of
the spinal cord, epilepsy is not very frequently produced. Therefore
the negative facts concerning the influence of this injury in man,
cannot be considered as a proof that man does not resemble animals
in this respect.

I think the following conclusions may be drawn from all that I
have said concerning the influence of alterations of the spinal cord
upon the production of epilepsy ; 1st. There cannot be any doubt
that in animals certain injuries to the spinal cord frequently produce
an epileptiform affection, if not true epilepsy. 2d. That in man
there are a great many cases which seem to prove that alterations
of the spinal cord may cause epilepsy.

Now, as we well know that the spinal cord has the same or-
ganization and the same vital properties, in animals and in man, it
seem-?, from the first of lhe:?e conclusions, that it may be stated
more positively than I have done in the second, that epilepsy may
result from alterations of this nervous centre.

<§> VIII. Physicians admit now, two kinds of epilepsy, one of
centric and the other of peripheric origin. I will try to show
that although it seems to be of peripheric origin, it may. in some
cases, be in reality of centric origin.

In animals, after an injury to the spinal cord, if we did not know
that this injury exist.-? and is the first cause of the disease, we should
be led to admit that it is of peripheric origin, in finding that an irri-
tation upon a very limited part of the*" spine produces fits. In a
very important case of epilepsy recorded by Odier, the same thing
has existed as in my animals. For many years the disease seemed
to be of peripheric origin, and the autopsy has revealed that this
was a mistake. This case is so interesting, in many respects, that
I will give here a summary of its principal points.

Case T.— A man had frequent cramps in the little finger of the
right hand. The contractions went on increasing in extent and fre-
quency ; they by degrees extended to the fore-arm, the arm and the
shoulder, always beginning in the little finger. At last they arrived
at the head, and then true fits of epilepsy, with loss of conscious*
ness, took- place. By means of two peculiar ligatures round the
arm aiid the forearm, and which the man could tie easily, when he
felt the first contractions of the little finger, the attacks were pre-
vented at every threatening for two or three years. Unfortunately,
one day he eat and drank too much, and, being intoxicated, he for-
got the ligature when the initial cramp appeared, and then he had
a violent fit. From this time the ligature had no more influence
over the fits ; they became very frequent and always began in the
litlle finger. Paralysis came on, and the patient died in coma.
Autopsy. — An enormous tumor was found in the left side of the
brain, below a place where the cranium had been wounded long
before {Odier, Mamiel de Medecine P raiiqiie, 2de edit., 1811, p.
ISO).

This case and the facts observed in my animals, positively show
that the apparent outside origin of epileptic fits does not prove that
there is not an organic cause in the nervous centres.

<§> IX. There is a great analogy between the aura epileplica, in
man, and the pain originating in the skin and face of my animals.
In them, as well as in man (when there is a real aura), the trunks
of the nerves seem not to possess the faculty of producing fits,
whereas their ramifications in the skin, or in the muscles, have this
power. In my animals, as vs^ell as in man, if there is an interrup-
tion of nervous transmission between the skin and the nervous cen-
tres, fits are no more seen, or at least their number is very much
diminished. I have collected many cases of epilepsy with an evident
aura epileptica, in Avhich there has been either a diminution of the
fits, or more frequently, a complete cure, after the interruption of
nervous transmission between the starting-point of the aura and the
nervous centres. In these cases, the following various means have
been employed with complete or partial success, either against the
aura epileptica or against its production : 1st, ligature of a limb or
of a finger ; 2d, sections of one or many nerves, and amputation
of a limb, or of other parts of the body ; 3d, elongation of mus-
cles which are the seat of the aura ; 4th, cauterization, by various
means, of the part of the skin from which the aura originates.

Istk Cases of application of a ligature, as a means of preventing
epileptic fits. The cases of cure of epilep^iy by the appUcalion of a
ligature are very numerous. Pelopt?, a teacher of Galen, seetns to
have been the first physician who employed a ligature to prevent
epileptic fits. Here is a summary of the relation given by Galen
of the case of Pelops :

Case II. — An intelligent young man, who did not lose his con-
sciousness during his fits, had a sensation originating in one of the
extremities, and ascending from thence to the head. His physician,
according to the advice of Pelops, applied a ligature in the middle
of the limb, above the part first affected. By this means, the fits
did no more lake place, although previously they used to come
every day. (Galen. De Locis affectis, lib. iii., c. 7.)

Favenlinus (quoted by Herpin, Du pronostic et du traitement de
Vepilepsie, p. 893) speaks of an old man who had the aura begin-
ning in a finger. After the application of a ligature round the finger,
he was cured. Daniel Puerari, and Salmulh (quoted by Herpin,
loc. cit., p. 398), relate cases in which a ligature round the leg
prevented the fits from taking place.

Bonet ( Sepulchretiwi, 1700, sect. 12, De Epilepsia, appendix, p.
292) relates a very interesting case, of which the following is a
summary.

Case III. — A man, 50 years old, at times had a swelling in the
groin. From this place, a sensation of prickling slowly descended
to tiie sole of the foot. When arrived there, the sensation rose
quickly to the brain, of which it attacked only one side, so that
convulsions look place only in the left side of the face and body.
The patient did not lose his consciousness, but his speech was alter-
ed, because the tongue had convulsions. The patient used to say
(but with difficuhy), "look, how this atrocious disease torments
me." A ligature was ^plied above or below the knee, as soon as
the swelling and the sensation appeared in the groin. He always
succeeded, by this means, in preventing the fits, until one evening,
when not having been able to place the ligature in good season, he
had such a violent fit that he died.

Camerarius (quoted by Herpin, loco cit., p. 403) relates a very
important case, which shows that in man, as in my animals, when
epilepsy begins, the aura epileptica may at first produce only convul-

sionsof some of the muscles in the neighborhood of ihe starting point
of the pain. The irritation of the sidn of the face or of that of the
neck, in my animals, as I have said, in <§,n., excites convulsions
only in the muscles of the face and neck on the irritated side. It is
a local spasm, by a reflex action, such as takes place often in the
muscles of the stump of an amputated limb. The case of Came-
rarius is very important in this respect.

Case IV. — A young man, in February and March, 1694, had a
spasmodic movement of the left middle finger, and, quickly after,
the other fingers and the hand had the same movement. This
spasm came on every four, five or six days, without any other trou-
ble in the patient's health. On the 5th of April, while he Avas
showing this spasm to his sisters, and laughing at it, suddenly a
convulsion of the whole arm took place, and he fell down in a
violent fit of epilepsy. From this time, fits came every three or
four days, or after a greater interval. They were always preceded
by a spasmodic movement, at first of two fingers, then of the other
fingers, and afterwards of the hand and fore-arm. From thence
the convulsion slowly extended to the arm, and to the muscles of
the neck. Then a rotation was produced in the head by this con-
vulsion ; the patient lost his sight, and afterwards his hearing, and
at last the attack took place. During the intervals of the fits, the
young man was in good health, except that he had a pain in the
hand, as if it had been frozen. Ligatures applied near the elbow,
with a large band, sometimes prevented the fit.

I will relate, in a moment, a case recorded by Herpin, in which,
as in the preceding case, the convulsions were at first limited to the
neighborhood of the origin of the aura epileplica. Boerhaave
(quoted by Herpin, loco dt., p. 405) gives the history of a young
man who at first had spasms and pain in his feet. During two
years, these spasms went upwards into the legs and thighs. At last
they attacked the right side of the body and the head, and a com-
plete attack of epilepsy came on. The paroxysm was always re-
tarded when a ligature was placed round the right leg.

In cases recorded by Olaiis Borrichius, by Baster, by Burnet, by
Ramazzini (quoted by Morgagni, De sedibm et causis morborum,
epist. 9, §8), by Van Swieten, by Lafler, by Tissot, by Liboschitz,
&c., we find that ligatures on the limbs have been more or less
completely successful, when there was a true aura epileptica. More

recenl observers have also been successful in employing ligatures ;
among ihem 1 will cilc Esquirol {TraiU des maladies meiila/es, vol.
i., p. 404) and Giberl, Sanclras and Piegu (quoted by Delasiauve,
Trailc de Epi/qjsie, 1854, p. 427-8).
A case reported by Herpin is worth being reproduced here :

Case V. — A young girl had something like cramps in the two
fingers of the left hand. There was a pain in the back of the hand,
and a spasmodic flexion of the fingers. This convulsion took place
three or four times a day, for two or three days. They ceased for
a few weeks, and then came again ; and for three days in succes-
sion there were two or three a day. In the evening of the last of
these three days, the girl was showing to her brother the contrac-
tion of her fingersj when her hand closed, the fore-arm and arm
were drawn upwards, so that the band touched her shoulder. A
very painful sensation accompanied the spasm of the arm, and from
thence it extended to the remainder of the body, and at last the girl
lost her consciousness. Either by means of a ligature, or of com-
pression made by her parents' hands, except once or twice, all the
threatenings of fits aborted. A treatment of oxide of zinc cured
the patient. {Pronostic el Irailemenl de VEpilejpsie, p. 71.)

Instead of a ligature, some physicians have employed with suc-
cess a tourniquet, CuUen (Elements of Medicine, <§>131S) and
Tissot . ""ve related cases of this kind.

In some ^ the patients in whom a ligature has been applied with
success, this mcc. ■=! has at other times failed to prevent the fit. What
are we to conclude u. this failure ? Is it that the ligature was
not well applied ? or that was applied too late ? or, at last, that
even applied very early and vt. tightly, there are cases where a
ligature cannot prevent the transmis. '">n to the encephalon of the
nervous irritation constituting the aura; Of these three things, the
first two certainly may have existed ; and ^ to the third, it seems
possible that a ligature, however well applieu. will not always in-
terrupt completely the nervous transmission. . fact w^hich I will
relate as the first case concerning the section o. nerves in epi-
le))ties, might perhaps be considered as proving this ii. efficiency of
ligatures.

''nd. Cases of section of a nerve as a means of 'preventing -
lepUcfits.

These cases are exlrcmeiy i — ';.-.nr because they establish

positively the curative influence of the interruption of nervous trans-
mission between the part where the aura begins and the nervous
centres. The resuhs of the section of certain nerves in my ani-
mals, seem, as I will show hereafter, to agree perfectly well with
what has been observed in man after this operation.

Case VI. — A servant girl had epileptic fits, preceded by a pain
at the extremity of the index of the right hand. A ligature around
the fore-arm, and other means, failed to produce any amelioration.
The branches of the radial nerve going to this finger were divided
during a fit, and the patient was completely cured. (Portal. Ob-
serv. sur le nat. ei le traitement de rEpilepsie, 1827, p. 159-60.)

In this case, the ligature had failed, but perhaps it was not
strongly applied. Portal says it was un peu forte, whereas it ought
to have been very tight.

Cullen (Elements of Medicine, ^12>V6) relates a case of cure by
the section of a nerve.

Short (Edinb. Med. Essays and Obs., vol. iv., p. 523) gives the
history of a case of epilepsy cured by the section of a nerve of the
leg, and the extirpation of a small tumor.

In the following curious case, the nerves, although not cut by the
knife, were divided.

Case VII. — A young soldier, who had had epilepsy for many
years, became much worse after having been bled in the feet. He
had three fits every day at regular hours, at 6 and 9, A. M., and 2,
P. M. A feehng of cold used to precede the fit, before the bleed-
ing of the right foot. The physician, M. Pontier, thought that
some nerve had been half divided, and that the increase in the fre-
quency of the fits depended upon the irritated slate of this nerve.
Various experiments were made concerning the influence of liga-
tures. At first, one was applied over the knee-joint, just before the
2 o'clock fit, which came, nevertheless, but lasted five minutes, in-
stead of twenty-five as usual. The next morning, the same result
was obtained. Thinking the ligature was not sufficient, M. Pontier
made use of the tourniquet, the pad of which Avas applied upon the
saphena nerve. The fit lasted only one minute and a half. The tour-
niquet having been loosened too soon, a universal spasmodic tremb-
ling took place, which disappeared at once when the instrument was
re-lightened. To make sure that the trembling came from the ab-
sence of compression, the instrument was loosened again, and the
3

trembling re-appeared, and ceased again when ihe pressure was
again increased. Analogous experiments were tried al ihe time of
another fit, and the result was the satne. When the place where
the bleeding had been made was irritated, the trembling took place
if the pressure was not considerable ; but it ceased when the press-
ure was increased. Before and during two other fits, the same facts
were again observed. M. Pontier then tried the application of a
ligature, not only on the right leg, but also on the left ; the fit then
did not take place. From time to time there were slight tremblings,
but the patient did not lose his consciousness. For three days tlie
same thing was done, and with the same success. Then M. Pon-
tier decided to divide the tvi'o saphena nerves, but thinking that the
bistoury might frighten the patient, and also being desirous of de-
stroying the cicatrices of the lancet wounds, he applied caustic pot-
ash on each of them. Since this time, the patient has had no fits.
( Recueil p6riod. de la Soc. de Med. de Paris, No, 79, p. 201, and
Journal Gen. de Med., vol. xvi., p. 261.)

This case is very interesting in many respects. In the first place,
it illustrates admirably the power of the ligatures upon fits. In the
second place, it shows the influence of ligatures, and of the section
of nerves, in cases where there is no positive aura epileptica. I
will speak of this point afterwards.

The cases of amputation for epilepsy which have been followed
by the cure of the patients, are to be compared to those of section
of nerves. It is, very likely, by the section of the organs of ner-
vous transmission, that an amputation succeeds in curing epilepsy.
Therefore we have thought proper to collect some of the CEises of
this kind which are on record.

The amputation of the great toe has cured a patient whose histo-
ry is given by Tissot, quoted by Delasiauve. [Loco cii., p. 430.)
This case is probably the same which Esquirol (loco cit., vol. i., p.
804) relates, without any mention of the physician who treated the
patient. He says, " A lady having vainly tried many remedies,
was cured by the amputation of the first phalanx of the great toe,
which was the source of an aura epileptica."

Dr. W. H. Edwards, of Virginia, has recently published a very
interesting case of a cure of epilepsy by an amputation. Here is
a summary of the case.

Case VIII. — For seven years a girl had epileptic fits, at irregular
intervals, sometimes five or six per week, then none, perhaps, for

two or ihree weeks. In one of her fits she fell on the hearth, and
burnt one of her feet. The injury produced by the burn was not
cured after five years, during which the fits were very violent.
The leg was then amputated a few inches below the knee-joint.
This was done in March, 1852, and since then (up to February,
ISoo) she has never had a return of the fits. (The Virg^inia
Medical and Surgical Journal, March, 1855, p. 204.)

There is an interesting case of cure by amputation in the Medi-
cal Examiner, of Philadelphia (1841, vol. iv., p. 477).

Perhaps we ought to add here the cases of convulsions which
have been cured either by the section of a nerve in amputated pa-
tients, or by a second amputation; but almost all the cases of this
kind are not true cases of epilepsy ; they are either more or less
local convulsions, or hysteriform convulsions. Besides, epilepsy
produced by alterations of the nerves of tlie stump in amputated
patients, is not frequently curable by the section of a nerve, on ac-
count of the inflammation of the whole or a great part of the length
of the nerve. A case recorded by Mr. Hancock, and another by
Mr. Langstaff", are very interesting specimens of this kind. (See
the Phila. Med. Examiner, July, 1852, p. 468.)

There is a very remarkable case of convulsions treated with suc-
cess by the section of a nerve, published by Dr. Harris, of Phila-
delphia. {Med. Examiner, 1833, vol. i., p. 2.)

I could relate many cases of tetanus in which the section of a
nerve has proved successful, but although these cases bear out the
fact I wish to establish, i. e., the influence of the interruption of
nervous transmission in preventing convulsions, 1 will not give
them, because I must here confine myself to the subject of true
epileptic convulsions.

Besides amputations of limbs, that of the testicles seems to have-
been successful in curing epilepsy. Joseph Frank relates a curious .
case of this kind, in which the aura epileptica began in one of the
testicles, which was the seat of an ulcer. It was taken off, and
eleven years after the operation no more fits had come. (Praxeas
mediccB universce prcecepla, vol. i., sect, iii., p. 476.)

3dly. Elongalion of muscles which are the seat of the aura.

The aura epileptica begins in the ramifications of nerves, either
in the skin or in the muscles. We have shown that after an inter-
ruption of nervous transmission by compression of a section of
nerves, the fits are prevented, or are less violent : we will now re-
late cases showing that when the aura has its seal in muscles, a good

means of interrupting the nervous transmission from them, or rather
of producing a change in the stale of the sensitive nerves of the
muscles, is to elongate them.

Gilibert, quoted by Herpin (loco cU., p. 404), relates a case of
epilepsy in which the fit began by a pain in the foot ; on the people
about the patient taking hold of her foot, and drawing- vpon it, the
fit did not come.

Maisonneuve (Reck, sur VEpilepsie, p. 19) gives the history of a
girl who had cramps, either in the leg or in the arm. If somebody
seized the cramped limb, and extended it with force, the general
convulsions did not come.

The same author relates (p. 189) the case of a young man whose
fits were prevented by the elongation of the muscles of the arm,
Avhich had cramps.

Another remarkable case is recorded by the same writer (p. 195).
A man had cramps in one of his legs, and one of his arms, before
the fit. If people came quickly enough to draw strongly his arm
and leg, the fit did not occur.

Bending the body, or the head, backwards or forwards, to elon-
gate the muscles which have a cramp, has been employed Avith suc-
cess by some epileptics ; so it was by a patient spoken of by
one of the annotators of Galen (see Herpin, loco cit., p. 396),
who used to bend his body forwards. So it was, again, by a pa-
tient who, according to Esquirol (loco cit., vol. i., p. 303), used to
bend his head backwards, and by this means avoided the fit.

I could give many other facts to prove the influence of elonga-
tion of the cramped muscles to prevents fits of epilepsy ; but the
preceding are certainly sufficient.

All the means hitherto spoken of, and by which fits are avoided
(ligature, section of a nerve, amputation, elongation of cramped
muscles), are alike in one thing ; they cut off" the communication
between the aura epileptica and the encephalon. The means I will
now speak of attain the same end, but in another way, which is, the
destruction of the aura. Both in my animals, and in man, these
last means are able to succeed.

4th. Cases of cure of Epilepsy by Cauterization and other local
means of modification of the parts from lohich originates the aura
epileptica.

There are a great many cases of this kind. They bear out the
same conclusion as the cases of section of a nerve, in showing that
the fits were caused by a peculiar influence originating from some

part of the skin. Cauterization of the skin of the face and neck by
the red hot iron, in my animals, seems to cure ihem, as I will show
hereafter. It appears, therefore, that there is something of the same
kind in the condition of the skin of the neck and face in these ani-
mals, and in the parts of the skin which are the seat of a true aura
epileptica in man.

The most varied modes of cauterization have been employed
with success against the aura epileptica. Blisters, moxas, potential
cauteries, issues, Dippel's oil, a decoction of ruta graveolus, and va-
rious other rubefacients, have been successful in cases reported by
Locher, Baster, Dovinetus, Brunner, Stuerlin, Henricus ab Heer,
Benzi, Portal, Recamier, &c.

It is useless to mention any of these cases particularly, because
there are so many on record that every one knows some of them.

The application of a moxa or of the red-hot iron is, I believe,
the best means of cauterization. At least it is so for animals, and
the many cases in which epileptics have been cured by a burn (see
Portal, loco cii., pp. 160 and 172) agree in showing the power that
burning of the skin possesses. In a case by Tulpius (see Herpin,
loco cii., p. 399), the aura came from the big toe, and the patient
was cured by deep burnings of this toe with the red-hot iron.

Any kind of change in the skin may be the cause of the appear-
ance of epilepsy or of its disappearance. A man, says Esquirol
(loco cii., p. 304), had an ulcer on one of his legs ; epilepsy came
on after the cicatrization of the ulcer, and each fit was preceded by
the sensation of a cold wind in the cicatrix ; a ligature above the
knee-joint stopped the fit. A young man, whose case is recorded
by Pouteau (quoted by Portal, loco cii., p. 375), had received a blow
on the head, and the wound was cicatrized only a year after ; he
was then attacked with epilepsy, and the fits gradually became
more and more frequent. After having been a year in this condi-
tion, he consulted Pouteau, who opened the cicatrix by the applica-
tion of the cautery. From this day the fits disappeared ; but
the patient allowed the wound to be healed again, and epilepsy re-
turned. It disappeared again, after another application of the
caustic.

Perhaps various operations which have been followed by the cure
of epilepsy are to be explained in the same way as the many cases
related in this paragraph. This is true, perhaps, for a case men-
tioned by Delasiauve (Traile de VEpilepsie, p. 430), and in which,
after the extirpation of an encephaloid tumor in the angle of the

jaw, an epileptic patient was cured. This explanation is probably
good, also, for some of the cases in which trepanning of the crani-
um has been successful in epileptic patients. Among the cases of
this kind that I know, I take four, almost at random, to show the
fitness of this explanation. In one of them, a circumscribed and
permanent pain in the head led Dr. James Guild to apply the tre-
phine. The patient was cured. (Dclasiauve, loco cU., p. 422.) In
another case. Dr. Campbell (Annales Med.- Psychol., vol. xiii., p.
613) applied the trephine on the cranium of a man who had re-
ceived a blow, and who suffered a great deal from the wound it had
produced. No more fits took place, and four years after the opera-
tion the man was still well. In a third case, recorded by Benjamin
Travers {A furlher Inquiry concerning Constitulional Irrilalion and
the Pathology of the Nervous System, p. 285), the trephine was ap-
plied in a place where the cranium was depressed and painful to
the touch. The patient was cured. The fourth case I will give in
full, as it has not yet been published, and also on account of its impor-
tance. I owe the history of this case to Professor Van Buren, of
New York, and I give it just as it has been furnished to me by this
distinguished surgeon.

Case IX. — " A healthy married woman, 26 years of age, receiv-
ed a blow upon the side of her head from the clenched fist of her
husband, who was intoxicated. The seat of the injury remained
permanently tender to the touch, and about five months afterwards
she had an epileptic fit, for the first time. The fits recurred from
this time in gradually diminishing intervals, and when she was ad-
mitted into the New York Hospital, in March, 1856, about three
years after the injury, they occurred almost every day.

" Over the centre of the parietal bone of the right side, a portion
of the scalp, about the size of a half dollar, was very sensitive on
pressure, but no appreciable lesion could be discovered, except,
perhaps, a slight pufliness of the integuments at this point. She
suffered much from headache, the pain always commencing here,
and seeming to radiate from this tender surface to the rest of the
head. Before a seizure of epilepsy this local pain, which was
always present, invariably became more intense.

" After watching the patient for some weeks, during which time
the fits were evidently becoming more frequent, it was observed
that she was worse at her catamenial period. In fact, upon the
5th and 6th of April she had no less than twenty-seven distinct sei-

znres. Her memory and other intellectual faculties were observed
to be decidedly impaired. In other respects her health was good.
Valerianate of zinc was tried in doses of two and three grains three
times a day during a fortnight, but without benefit.

" It was then decided, in consultation, to explore the condition of
the scalp and cranial bone at the seat of pain, and to remove a por-
tion of the bone, if it showed any evidences of disease. This was
done on the 10th of May. The patient was etherized, and a free
crucial incision made through the scalp. The periosteum was found
more than naturally adherent to the bone, the surface of which was
somewhat elevated and roughened over a space an inch and a half
in diameter. This altered portion of bone was removed by two
applications of the trephine ; its inner surface was found to be per-
fectly normal, but its diploe was obliterated.

" The wound was closed accurately, except at the point where
the incisions crossed, and cold water dressings applied. No fit oc-
curred until the 18th of May, when she had three during the day
and evening, followed by active febrile symptoms, with nausea, and
on the following day an erysipelatous blush appeared upon the fore-
head. On the 19th and 20th she had three fits, but they were not
very severe. The attack of erysipelas lasted the usual time, and
proved to be rather a severe one. The wound of the scalp healed
kindly and uninterruptedly, and, at the end of the erysipelas, was
entirely cicatrized (May 27lh). After the seizure which occurred
on the 20lh, there was no return of the epilepsy. The patient
was retained in the Hospital until after a menstrual period, and as
this did not take place at the usual time, appropriate remedies were
employed, but it was not until the sixth week that the catamenia
returned, so that the patient was not discharged from the Hospital
finally until July lOlh, having had no fit meanwhile.

" The epileptic fits which occurred on the 18th, 19th and 20th of
May, coincidently with the invasion of the erysipelas, seem to
have taken the place of the usual chill, as her attack commenced
Avithout one ; and they were the only fits which occurred after the
operation of May lOih.

" I have seen the patient twice since her discharge from the Hos-
pital, once within the past month (November), and she is in per-
fect health, having had no threatening whatever of an epileptic fit
since those which ushered in the attack of erysipelas."

The extirpation of two pieces of altered bone in this case has
certainly not been the cause of the cure of the patient, as there have

been fits after llicir removal. We are led, therefore, to acJmit that
the cure was the consequence either of the influence of the erysipe-
las or of a change that took place in the skin while the wound was
healing. There are cases on record where either erysipelas, or
some other febrile disease, seems to have cured epilepsy; but this is
so very rare, that it is much more j)robable that in the patient of Dr.
Van Buren the cure has been effected by the change that the opera-
tion has produced in the skin, just where the blow which had caused
the epilepsy had been received. The frequency of cures of this
convulsive disease by anything that may produce a change in apart
of the skin, which, being injured or the seat of a pain, has caused
epilepsy, renders it very probable that in this case the cure has been
obtained by the change produced by the operation.

While I think that Dr. Van Buren deserves great eulogy for this
bold and successful operation, I nevertheless ought to say that with
the knowledge that 1 have now, that epilepsy originates very fre-
quently in the skin, it would be necessary in the future, in cases
like those 1 have just recorded, to employ various means of cauteri-
zation, and particularly the application of a red-hot iron, upon the
injured skin, before making use of the trephine. Very likely cau-
terization, in a number of cases, will prove sufficient to cure.

Perhaps we are authorized to place the cases we will speak of
now, among those in which the skin was the source of an aura
epileplica.

J. Carron {Journal General cle Medecine, vol. xiii., p. 242) relates
the following case.

Case X. — A child, II years old, had fits of epilepsy two or three
times a week, since he was 2 years old, A feeling of cold, com-
ing from one of the upper extremities, preceded the fits. A liga-
ture having been applied around the arm and tightened at each
threatening, the fits were avoided. A small tumor was then found
on the first phalanx of the thumb, and to ascertain if this tumor was
the cause of the fits, although it did not produce pain, the ligature
was placed successively on the hand and on the thumb, and the fits
were prevented. An incision was then made upon the tumor, and
four very small bodies of hard sebaceous matter were taken out.
The wound was excited to give much pus, and healed after thirty
days. The child was completely cured, and has never had a fit
since.

Portal ( Analomie Mcdir.ak, vol. iv., p. 217J gives the case of a

woman whose fits began by a pain in ihe thumb. Leduc, a pupil of
Portal, extirpated a hard portion of the skin (a bunion, very likely —
■un durillon), and the patient was cured.

A foreign body in Ihe ear had caused epilepsy. Fabricius Hil-
danus extirpated it, and the patient was cured. (Esquirol, loco cit.,
vol. i., p. 303.)

Esquirol says (loco cit., vol. i., p. 303) : " Donat attended a
nun who felt, in the beginning of the fits, a pain in the right mamma,
from which the aura ascended to the brain ; if an ulceration took
place in the mamma, the fit was prevented."

Although the skin is more apt to produce epilepsy than the trunks
of nerves, there are many cases where an injury to the trunk of a
nerve has caused this disease. Such cases have been recorded by De
Haen, Henning, Larrey, Romberg {Nervenkrankheiten, 3d ed., vol.
i., part 2, p. 6S9) and others. I will relate some cases of this kind
to show that for them, as for those in which the aura epileptica
originates in the skin, the same principle is true, that an inter-
ruption between the injured part and the brain is able to cure
epilepsy.

Portal (Observ. sur V Epilepsie, p. 210) gives the case of a man
who had had a nerve injured in the arm. Convulsions, with loss of
consciousness, came on many times. A greater incision was made
where the wound existed, and the patient was cured.

The same writer [loco cit., p. 156) speaks of a man who had
received a pistol shot in the neck, and who had become epileptic.
After some time an abscess Avas formed in the neck ; one of the
shot came out, and the patient was cured.

Dieffenbach {Die Operative Chirurgie, vol. i., p. 852) relates the
case of a young girl, whose hand had been wounded by a piece of
bottle glass. Neuralgic pains, epileptic fits and contraction of the
limb had been the results of the wound. The cicatrix was opened,
and a small bit of glass was found near a nerve which had been di-
vided by it, and which was swollen and hardened. After the ope-
ration the neuralgia, the epilepsy and the contraction vanished, and
the girl was completely cured.

Fizes, according to Portal (loco cit., p. 157), has seen a man
who had become epileptic after having been wounded by a sword
near the great angle of the eye, and who was cured after the ex-
tirpation of a small part of the point of tlio sword which had staid
in the wound.

Cases more or less resembling the preceding liave been reported
by Lamolte, Van Swieten, Sauvages, De Haen, Burserius, Lamo-
rier, &c.

Darwin reports that he once saw a child who frequently fell down
in convulsions. A wart was found on ihe ankle, which was cut ofi',
and the fits never recurred.

Epilepsy caused by the irritation of the dental nerves, and cured
by the extirpation of some teeth, or by the lancing of the gums, is
not uncommon. Some interesting cases of this kind have been re-
ported by Portal {loco ciU, p. 205 and elsewhere).

I shall not speak here of the cases of epilepsy produced by an
irritation of a mucous membrane, or of a viscus, and which have
been cured by the removal of the irritation. These cases are very
numerous, and they also prove that epilepsy may be cured by the
suppression of the irritation of nerves, either in their peripheric
ramifications or in their trunks.

§ X. In the preceding parts of this paper I have given a sum-
mary of two series of facts : experiments upon animals, and pa-
thological cases observed in man. I have now to compare these
two series of facts one to the other, and to draw conclusions
from the results of this comparison.

There is one thing which seems to be quite proved by this com-
parison : it is that the convulsive affection produced by certain in-
juries to the spinal cord is true epilepsy, or at least an epileptoid
affection. I have shown already that the symptoms (see §§ 11.
and V.) lead to this interpretation. But this is not all; the great-
est analogy exists between what we know of the aui-a epileptica
in man (see § IX.) and what I have found concerning the property
that the skin of the face possesses of producing fits in my animals
(see § IV.). In them it seems that the face is the starting point
of a true aura epileptica, and that, as well as in man, an interrup-
tion of nervous transmission between the starting point of the
aura and the cerebro-spinal axis, seems to cure epilepsy. The
same result seems also to be frequently obtained by either burn-
ing or other means of cauterization of the skin in the part from
which originates the aura. In these animals, as in man, in the
cases we have related, the convulsions seem to take place by a
reflex action. In these animals also, as well as in man (for in-
stance, in the case of Odier, § VIII.), although the primitive cause

of the affection is in the nervous centres, there is an aura epilep-
tica coming from the skin, and the interruption of nervous trans-
mission from the skin to the cerebro-spinal centres seems to have
been sufficient, for a time, to prevent epilepsy. Besides, the de-
velopment of epilepsy in many cases in man is similar to what
takes place in my animals : the convulsions at first are limited to
a few muscles around the starting point of the aura epileptica ;
they then extend gradually to many others, and, at last, attack
almost the whole body.

If these analogies prove that the convulsive disease which is
produced in animals by an injury to the spinal cord is epilepsy,
we are led to conclude that in man, also, epilepsy may be caused
by a disease of this nervous centre. This gives a new weight to
the great probability that epilepsy has been the result of altera-
tions of the spinal marrow in at least some of the cases (see §Vn.)
where this organ has been found altered in epileptics.

It will perhaps seem strange that we speak only of a great
probability, while some physicians consider the question of the
production of epilepsy by a disease of the spinal cord as quite
decided, and describe a spinal epilepsy as a distinct form of this
affection. I deny the existence of this species of epilepsy, as it
has been characterized by many German writers and by Dr. J.
Copland ; and I consider as a fanciful description the pathological
and symptomatic history of this form of epilepsy given by Joseph
Frank, Harless, Schoenlein, Dr. Copland, Canstatt, Colson and
Wunderlich.

Dr. Copland says (Diet, of Pract. Medicine, 1844, vol. i., art.
Epilepsy,^. 793) that the spinal epilepsy generally arises from
injui-ies and concussions of the spine, from caries of the bodies of
the vertebrae or inflammation of the intervertebral substance, and
from inflammation of the membranes of the cord, or effusion
of fluid within the sheath ; from the metastasis of rheumatism, or
the disappearance of eruptions, &c. According to Schoenlein and
others, it arises frequently from excess of sexual excitement, and
particularly from onanism. Sometimes it is preceded by great sen-
sibility, formication or irritation of the skin. The fits are generally
characterized by severe convulsions, seminal emissions, and ex-
pulsion of urine and faecal matters. The head is seldom so much
affected as in cerebral epilepsy, and the seizures often approach
nearly or altogether to simple convulsions. One or other of the

limbs is frequently Aveak, and sensation in them occasionally di-
minished or otherwise altered during the interval (Copland).
According to the German physicians the convulsions resemble
those of tetanus, and attack mostly the extensor muscles ; clonic
convulsions are rare. Besides, there are symptoms of diseased
spine, and particularly pain under pressure in some points.

Dr. Copland believes that disease of the spine, associated with
disease of the uterine function and epilepsy or convulsions, is
not rare. He says, also, that in epilepsy depending upon injury
of nerves, the paroxysm, as in the spinal variety, is rather one of
convulsions than of complete epilepsy {loco dt., p. 793).

The same writers describe as another distinct kind of epilepsy
what they call the cephalic or cerebral epilepsy, in which convul-
sions are mostly clonic, and not so violent as in the spinal variety,
and the loss of consciousness is the prominent symptom.

In their description the German writers and Dr. Copland have
confounded three distinct things : first, cases of disease of the
spine, or its contents, with convulsions (and not epilepsy) ; second,
cases of disease of the spine, or its contents, with epileptic fits,
without loss of consciousness ; third, cases of disease of the spine,
or its contents, with epileptic fits and loss of consciousness. An
inflammatory disease of the intervertebral substance, or of the
membranes of the cord, &c., is not epilepsy. At first this con-
vulsive affection is not a febrile one, while these inflammations
cause more or less fever; then the fits of epilepsy are separated
by long or short intervals, during which there are no convulsions,
while it is not so in these inflammations, or, at least, the inter-
vals are very short in them ; and besides, the disease progresses
quickly towards death or cure. It is wrong, therefore, to call spinal
epilepsy cases of meningitis, &c., in which there are more or less
continuous convulsions and fever.

As to the other kinds of cases, called spinal epilepsy by Cop-
land and others, they do not deserve this qualification, unless we
call them so because epilepsy seems in them to be caused by a
disease of the spine or its contents. But there is notliing special
in the symptoms which can lead us to find out that the epileptic
fits depend upon a spinal affection, and not upon a disease either
of the brain or nerves. Of the two kinds of cases : spinal com-
plaint with epileptic fits and conservation of consciousness, and
spinal complaint with epileptic fits and loss of consciousness ; this

last kind has certainly nothing to distinguish it from the cerebral
epilepsy of Copland and others, and as to the other kind it is im-
possible, also, to distinguish it from the cerebral form, because
consciousness may also not be lost in cases of epilepsy due to a
cerebral disease.

The symptoms in my animals, in which the primitive cause of
epilepsy is certainly an injury of the spinal cord, and the symp-
toms in many cases of epilepsy in man, where a disease of the
spinal cord or its membranes existed, are entirely like those ob-
served in many cases in which the brain was the only organ alter-
ed. Still more, in the same patient there may be the symptoms
of the so-called spinal epilepsy in one attack, while in the next
we find those of the so-called cerebral epilepsy, and vice versa.

In epilepsy due to a cerebral disease, there are, sometimes, all
the symptoms attributed by Dr. Copland and others to their spi-
nal epilepsy: violent tetanic spasms, seminal emission, expulsion
of urine and fgecal matters, paralysis of one limb and loss of con-
sciousness. For the existence of paralysis of one limb in epilep-
sy depending upon cerebral disease, I will refer to a paper of M.
Bravais (Thdse sur VEpilepsie HimipUgique, Paris, 1827), and
to the work of Dr. R. B. Todd (Clinical Lectures on Paralysis,
Diseases of the Brain, 6)'c., 1 854. Lect. xiv. On Epileptic Hemi-
plegia).

On another side I could relate a number of cases in which the
convulsions were clonic and consciousness lost, and in which epilepsy
co-existed with a disease of the spine or its contents. Some in-
teresting cases of this kind are to be found in the works of Her-
pin (p. 133-38) and Portal (p. 26 and p. 286). A relation of
two cases of disease of the membranes of the spinal cord and
softening of a part of this organ, with violent epileptic convul-
sions and loss of consciousness, is given by M. Pageant ( Reck,
sur les causes, le siege et le traitement de VEpil. These. Paris,
1825. Ohs. v., p. 22, and Ohs. xii., p. 33). In one of the cases
of tubercles in the spinal cord, recorded by Gendrin (see Traite
des Mai. de la Moelle epin. par Ollivier d'Angers, 3e edit., 1837,
vol. ii., p. 502), there were convulsions and loss of consciousness.

It is to be regretted that in a case of alteration of the spinal
cord, very much resembling that which most surely produces epi-
lepsy in animals, the symptoms have not been fully described.
Prof. E. Geddings, of Charleston, who relates this case, merely

says ; " Rather a stout man was affected, at frequent intervals,
with violent convulsions and much suffering for upwards of eigh-
teen months. In the progress of the case, the convulsions be-
came more violent and recurred at shorter intervals, until he was
finally released by death." There was an exostosis of the sec-
ond cervical vertebra, encroaching so much upon the spinal cord
as to produce a complete section of a lateral half of this or-
gan. (North American Archives of Medical and Surgical Sci-
ence. Baltimore. 1835. Vol. I., p. 110.)

In reviewing all the symptoms which exist in epilepsy, not one is
found to belong exclusively to epilepsy due to a disease of the brain,
of the spinal cord, or of a nerve. Even the existence of the aui-a
epileptica is not a proof that the primitive cause of the disease is in
some cutaneous nerves, and not elsewhere. The case related by
Odier (see § VIII.) shows that a tumor in the brain, producing
epilepsy, may be the cause of - an aura beginning in the skin. An-
other case, recorded by Herpin (loco cit., p. 125), resembles the
preceding, as there was an aura epileptica in a girl whose epilep-
sy was probably due to tubercles in the nervous centres. In my
animals there is no doubt in this respect, as the irritation of cer-
tain parts of the skin produces fits, although the primitive cause
of the epileptoid affection is in the spinal cord. The aura may
therefore exist in epilepsy depending upon a disease either of the
brain or of the spinal cord, as well as it is known to exist in
epilepsy due to alterations of cutaneous or other nerves.

I have had a direct proof that the symptoms of epilepsy de-
pending upon an alteration of a nerve could be exactly the same
as those existing in epilepsy due to an alteration of the spinal
cord. In a guinea pig in which one of the toes had been bitten,
there were fits entirely similar to those which are found in ani-
mals of the same species after an injury to the spinal cord, and
the fits ceased after a section of the sciatic nerve.

The comparison of what I have seen in animals with what has been
observed by others and myself in man, shows that the symptoms
of epilepsy cannot indicate whether it originates from a disease
of the brain, of the spinal cord, or of a nerve. But it is true,
nevertheless, that if together with epilepsy, there are positive symp-
toms depending upon a disease of either of these organs, it will
be very probable that epilepsy itself depends upon this disease.
The careful examination of the symptoms which co-exist with

epilepsy is, tliercfore, extremely important, because by tliem we
may find -whether this convulsive affection is due to a disease of a
nerve, of the spinal cord, or of the brain, and this knowledge is
of the greatest value for the prognosis and the treatment.

§ XI. I have been led to believe, by what occurs in animals after
an injury to the spinal cord, and by some cases observed in man,
that the existence of a particular spot capable of producing fits,
when irritated, is not rare in epileptic patients. This spot may
or may not be the starting-point of an aura epileptica.

In the interesting thesis of M. Bravais (Rech. sur les sympt. et
le traitement de VEpilep., Paris, 1827, p. 18), there is a case of a
man who had fits when he touched himself, or was touched by
other persons, on the region of the temporal bone of the right
side.

Pernel, according to Esquii'ol (Loco cit., p. 302), saw epilepsy
produced each time pressure was made on the upper part of the
head.

Rondelet (Methode curative des Maladies, p. 137) relates the
case of a man who had a fit every time his ears were exposed to
cold.

In a young man in whom there was an aura epileptica starting
from the left hypochondrium, a simple pressure on this region was
sufficient to cause the fit (Tulpius, quoted by Portal, loc. cit.,
p. 180).

While I was lecturing on this subject in Boston, in No-
vember last (1856), Prof. E. H. Clarke told me that he had
seen a fit of epilepsy produced by pressure upon one of the
mammae.

I have found that irritation of certain parts of the skin by gal-
vanism caused fits in two epileptics. In one of them it was the
skin of the bend of the elbow, and in the other the skin of a por-
tion of the neck and face. There was no sensation of an aura epi-
leptica in these two cases.

Probably in many cases, without the feeling of an aura epilepti-
ca, and even without a feeling of pain arising from any part of the
skin, the fits are caused by a peculiar and unfelt kind of irritation,
originating from some part of the skin, or from the sensitive nerve
of a muscle. Perhaps it will be possible to detect the existence
of such parts of the external tegument, or of such nerves, by va-

rious meaus, of wliieli wc will speak hereafter. It is certainly
impossible to admit that the sensations which exist when there is
an aura epileptica are always the causes of the fits, as we know
that sometimes they consist only in a feeling of cold, or a kind of
tickling- or formication, or a slight pain. Such sensations are cer-
tainly unable to produce fits, and therefore there must be some
other kind of irritation, not felt, existing together Avith these sen-
sations, starting from the same point, and producing the fit.
Consequently, what is essential in the aura epileptica is not
what is felt, but an unknown kind of irritation. This special
irritation, we repeat, may exist alone, i. e., without any kind of
sensation. It is the essence of an aura, without any feeling. A
good illustration of this view may be found in some cases record-
ed by M. Pontier (see above, § IX., Case VII.), J. Frank, and Hen-
ricus ab Heer. In the curious case we owe to M. Pontier, there
was no pain arising from the feet, and nevertheless it is certain
that an irritation sprang from them, as we find that the fits were
prevented by the application of a ligature round the legs, and
afterwards by the section of the saphena nerves. In the case
mentioned by J. Frank (Praxeos medicce. universfs precepta, vol. i.,
sec. 3, p. 476), epilepsy had come after a disease of the testicle;
the scrotum was much contracted during the fit, and although there
was no feeling of an aura, castration was performed, and the patient
cured. It is evident that in this case the fits were due to an unfelt
aura arising from the testicle. In the case by Henricus ab Heer
(cited by Sennert, Opera Omnia, vol. ii., p. 489), a young girl
had no feeling of an aura epileptica, but as she rubbed her big
toes one against the other during the fit, applications of butter
of antimony were made upon them, and the patient was cured.
It seems that in this case, also, there was, as cause of the fits, an
unfelt irritation arising from the toes. It is well known that
worms in the bowels may cause epileptic fits, although they some-
times do not give pain or any other sensation. The irritation
producing the fits is then unfelt, as in the preceding cases.

On one side, therefore, we find that an irritation coming from
the skin or a mucous membrane may produce fits, without being
felt ; whereas on another side, when there is the feeling of an aura
epileptica, the variety of the sensations, and their feebleness, often
show that it is not they which cause the fit, so that we must admit
that even tlioii it is a pt^'iiliar. unfelt irritation which produces the

attack. In my animals, as I have tried to prove in § IV., it is no
the pain caused by pinching the skin of a part of the face anc
neck which produces the fit, but a peculiar kind of irritation.
Perhaps the special irritation which generates a fit gives some-
times a sensation quite special also, and which cannot be described.
Many epileptics speak of a strange and inexplicable sensation.
M. Delasiauve thinks he has been enabled to judge upon himself
how a sympathetic fit is produced. He had a sore throat, with an en-
gorgement of the cervical ganglions. The least pressure upon these
inflamed glands caused a sudden bewilderment ( eblouissement).
The experiment, repeated twenty times, always gave the same re-
sult. M. D. says that if the pressure had been continued he would
have fainted, and that there was quite a special sensation, progress-
ing as quickly as a flash of lightning from the diseased spot to the
head (loco cit., p. 33-34).

In the cases of epilepsy in which there is an unfelt irritation
arising from the skin, and producing the fits, is it because the irri-
tation causes immediately a complete loss of consciousness, or be
cause it has not the power of giving sensation, that it is not felt ?
I cannot answer this question positively. I can only say that it is
probable that the two things exist.

K we take notice of these three sets of facts — 1st, that there
are cases of epilepsy in which an irritation arising from the skin,
or from the neighboring parts, may cause fits without being felt ;
2dly, that by pressure or galvanization we may produce in a part the
kind of unfelt irritation which causes fits ; 3dly, that such a part
being found, epilepsy may be cured by either the application of
ligatures, the section of a nerve, or cauterizations, &c. ; it becomes
evident that it is of the greatest importance to try to find out, in
epileptics who have no aura epileptica, if there is not a part of the
skin or of a muscle from which arises an unfelt irritation causing
the fits. To ascertain the state of things in this respect, various
means may be employed. If the fits are frequent, and if they
come at regular times, it will be found, by placing tight ligatures
around the limbs, whether the attacks are due to an irritation
coming from these parts, or not. Among other means of detect-
ing the existence or absence of a peripheric irritating cause of the
fits, I will point out particularly the following : pressure upon the
various parts of the body ; the application of localized and power-
ful galvanic currents; the application of ice and of a wet and
5

■warm sponge, &c. If any part is the seat of a pain, even if this
pain seems to have no relation with the fits, it will be necessary
to ascertain whether pressure, galvanism, &c., applied upon this
part, produce an attack. If it is in a limb that a pain exists, a
ligature will decide the relation of the painful spot with the fits.
In cases where there is a cramp in some of the muscles, or in one
only, at the beginning of the fit, the inducement of a cramp by
galvanism might decide if the attack is due to the irritation of the
sensitive nerve of the contracted muscle, or if the cramp is nothing
but a manifestation of the attack. If the initial cramp exists in
a limb, an elongation of the contracted muscle, or a ligature, might
lead to the solution of the question.*

The danger of producing a fit by the employment of some of the
means that I have indicated as good to decide if there is an unfelt
irritation arising from the skin, or from some muscle, and causing
the fits, is not a reason to prevent our making use of these means,
because the existence of a fit, particularly when we are prepared
for it, is a small evil in comparison with the great benefit that
may be derived from such a trial.

In my animals, nothing in the skin of the face and neck (except
a slight congestion, which perhaps is the result of the pinching,
and other modes of excitation that I employ) indicates that this
part has such a power as that which it alone possesses, to cause
fits when irritated. It results from this fact, that it would be
quite wrong to decide, a priori, that an epileptic man, in whom the
skin seems to be perfectly healthy, cannot have fits produced by
an irritation of some parts of his skin. Even in such a case,
therefore, it would be necessary to employ the various means I have
indicated, to decide the influence of the skin on the production of
the fits.

§ XII. In many of the preceding parts of this paper I have
strongly insisted on the influence of the aura epileptica, or of a
peculiar kind of irritation of the peripheric nerves, as causes of
epileptic fits. I must now show that I was right in this respect.

Herpin, in his important .work which I have so often quoted [lo-
co cit.,]). 421), tries to prove that the phenomena of the aura
epileptica are nothing but the result of a cramp in one or in more

* No one will imilale a surgeon, cited by Portal {loco cii., p. 135), who performed an ampula-
on of one of the toes, because the movements of this toe were very violent during the fit !

muscles, and that this cramp is the first convulsion of the attack.
The same view had already been proposed by Prichard, who says
that the aura generally is " a convulsive tremor commencing in a
limb " (A. Treatise on Diseases of the Nervous System, Part first,
1822, Note, p. 88-89). Herpin has gone farther, and tried to
prove that this is always the case. He thinks that the aura epi-
leptica, or, in other words, the first cramp, depends upon a change
in the nervous centres, and that the seat of the aura varies
according to the place where the change begins in these centres.
The cause of the attack, according to this theory, is in the cerebro-
spinal axis, and the aura is only a manifestation, an effect, of this
cause, and, in consequence, cannot be considered as a cause of
the fit.

This theorj^ implies that the so-called sympathetic epilepsy does
not exist; so that it is a denial of the peripheric origin of epilepsy.

I cannot understand such a denial, because I think there cannot
be any doubt as regards the existence of the sympathetic epilepsy,
when we take notice of the immense number of cases of this dis-
ease in which it has been produced by wounds or blows in various
parts of the body, by neuromas, or other tumors, by dentition
or decayed teeth, by foreign bodies, by worms, by calculi and
other concretions, by diseases of the skin or of the trunks
of nerves, &c. I will merely refer to the works of Portal
(loco cit., p. 155-185, p. 204-214), Esquirol (loco cit., vol. i., p.
297-305), Delasiauve (loco cit., pp. 217 and 253), and Romberg
( Nervenkrankheiten, 3d ed., 1855, vol. i., part 2, pp. 689 and 700),
where a great many such cases are reported.

When I treat hereafter of the nature and seat of epilepsy, I
will try to show that almost always, if not always, there is in this
disease an increased degree of the reflex excitability of the cere-
bro-spinal axis, and that epilepsy seems to consist mostly in this
increased excitability. When a wound, or any of the known causes
of the sympathetic epilepsy, produces this affection, it does so prin-
cipally, if not only, by increasing this reflex excitability. I will
show also, hereafter, that there are two distinct influences belong-
ing to the various causes of the sympathetic epilepsy : by one,
they produce the disease, or rather, the principal element of the
disease, i. e., an increase of the reflex excitability ; by the other,
they produce the fits. I refer, I repeat, to the writers I have just
quoted, for facts proving that the^ may produce the disease, and J

will now only try to show, in opposition to the theory of Dr. Her-
pin, that they often cause the fits. I will also try to show that
many kinds of felt or unfelt irritation of the sensitive nerves of
the skin, or of the muscles, have the same power.

A great many facts are opposed to the view that the aura results
always from a cramp. In the first place, if this view were true, the
sensation of the aura should always be felt where there are mus-
cles, and not in those parts, such as the fingers, toes, skin, mammae,
testicles, ears, &c., where there are no muscles, and where, there-
fore, there cannot be any cramp. In taking notice only of cases
reported by Herpin himself, in his learned historical account of
the aura epileptica, we find that in a number of them the aura
originated in the following parts : the little finger (two cases, one
by Brassavola, the other by Hollier) ; the thumb (one case by Bou-
chet and Cazanvielh) ; a finger (one case by Faventinus); the big
toe (four cases — two by Tulpius, one by Sylvius, and one by Por-
tal); a cicatrix on the foot (one case by Puerari) ; all quoted by
Herpin {loc. cit., pp. 393, 394, 395, 398, 416 and 417). I might
have given a much longer list by taking facts from other writers,
ancient and modern. There are many other facts in opposition to
the view of Herpin, in his own work, some of which have been ob-
served by himself. There are cases in which there was a cramp,
but, at the same time, a pain in parts where there was no cramp, and
it is remarkable that the patients complained of this last pain only.
So it was particularly in two cases observed by Herpin himself
(Case xi., p. 70; and Case xix., p. 134).

If the view of Herpin were true, the sensations of the aura epi-
leptica should be always the same, and always those of a cramp.
Listead of such a thing, it is well known that these sensations vary
extremely, and that they are described as a feeling of tickling, formi-
cation, burning, cold, &c. It would be easy to give a long list of
cases in which these sensations have existed. Romberg, who ad-
mits two kinds of aura, a sensitive and a muscular one, says that
the sensitive aura, in some of his patients, consisted of a feeling of
formication in the extremities of the fingers and toes, and in others
a tickling sensation around the mouth (loco cit., p. 674).

Herpin says (p. 421-422), that he partially believes that epilep-
sy has been cured permanently or temporarily, and that the fits
have been prevented, by stretching the limbs, frictions, ligatures,
section of nerves, cauterizations, extirpation of parts, amputations,

<fec. These facts are certainly in direct opposition to his theory,
and he feels much embarrassed about them. He tries, nevertheless,
to show that there is no contradiction between his doctrine and
these facts. His reasoning in this respect can prove only one
thing, which is, that almost all the successful modes of treatment
above enumerated are very powerful to diminish or prevent a cramp.
But Herpin does not show how or why the prevention of a cramp
cures epilepsy. Certainly it ought neither to cure the disease, or
even to prevent the fit, as, according to the theory, the cause of the
fit is in the nervous centres, and the aura, or first cramp or convul-
sion, is nothing but one of the effects of this cause. Of course, a
cause is not destroyed, or rendered unable to act, because one out
of many of its effects is annihilated. Herpin, very likely, has been
aware of this inefficiency of his theory, as he tries to show — 1st,
that besides cauterization, in some cases, powerful remedies have
been employed; 2d, that he considers as doubtful some of the
cases of cure by the extirpation of a tumor ; 3d, that some opera-
tions have cured, for the same reason that fever and ague, typhoid
fever, variola, &c., have.

I am surprised to find this last argument employed by Herpin,
as there is nothing similar in the various operations performed for
the cure of epilepsy, and these diseases. The alterations in the
blood, and the changes in the nutrition of the nervous system which
exist in these fevers may cure epilepsy, but in operations consisting
in the application of a ligature round a limb, or in the section of a
nerve, or in the extirpation of a tumor, there is nothing capable of
altering materially the blood, and the nutrition of the nervous sys-
tem. As to the other arguments of Herpin, they are valuable, but
they apply only to a small number of cases.

To show the incorrectness of the view of the Swiss Physician, it
might be sufficient, I believe, to remind the reader of the cases
of cure of epilepsy that I have given in a preceding section of this
paper (see § IX.). They prove peremptorily that the source of fits
of epilepsy may be in the peripheric part of sensitive nerves. The
fits were certainly due to an external cause of irritation in cases of
epilepsy where they have been prevented by the following means :

1st. Application of a ligature around a limb or finger.

2d. Section of a nerve.

3d. Amputation of a limb, a finger, a toe, or the testicle.
4th. Extirpation of a tumor, a foreign body, or a tooth.

Sth. Expulsion of -worms, of calculi or other concretions.

Some other facts which I have mentioned in the beginninf? of
§ XL show, in the most direct way, the possibility of the produc-
tion of a fit by an irritation of the periphery of the sensitive
nerves. Together with these facts, I might have spoken of a young
man, observed by Zimmerman, and who had a fit of epilepsy every
time he practised masturbation (Esquirol, loco cit., p. 301). That
an external irritation may cause fits is also proved, without any
doubt, by the facts I have almost daily observed in animals for
many years ; facts described in the first part of these papers. It
even seems, from what is observed in these animals, and from va-
rious circumstances observed in man, that when there is a cramp
preceding a fit, the cramp is nothing but the first effect produced by
the irritation of a sensitive nerve. Cramps in some of the muscles
of the neck and face are sometimes the only effects of the excitation
of the skin of the neck and face in my animals, and when a com-
plete fit takes place, it is almost always preceded by the spasmodic
contraction of these muscles. So that if we did not know that
there had been an irritation of the skin, we might think that the
first phenomenon was the cramp of these facial and cervical mus-
cles. In cases of wounds of a nerve, two diseases may follow, epi-
lepsy or tetanus, but in these two cases the first convulsive phe-
nomenon is a cramp in the muscles in the neighborhood of the
wound. Many facts of this kind have been collected by Swan' (A
Treatise on the Diseases and Injuries of the Nerves, nevr edition)
and Pfliiger (Die sensorischen Functionen des R'uckenmarkes,
1853). If the wound was not known to exist in a case of epilep-
sy of this kind, the local cramp would be considered as the first
phenomenon of the attack, while it is only a secondary one. Now,
if, as I have tried to show in § XI., there may be an unfelt irrita-
tion in the periphery of sensitive nerves, causing fits of epilepsy,
it is possible that in cases where a cramp in one or a few muscles
is the only thing felt by the patient, the cramp is not the fii'st phe-
nomenon, but results from the irritation of sensitive nerves in its
neighborhood. In cases where there is both pain in a part without
muscles, and cramps in the neighboring muscles, it may be that the
cramps are the result of the irritation of sensitive nerves, causing
this pain.

We do not deny that the first cramp in epilepsy may be due to
some direct or primitive irritation of the nervous centres, but we

do not know any cases of this kind ; while, on the contrary, we
know many cases where there was, in the beginning of the fits, a
local cramp, resulting from a secondary irritation of the nervous
centres, i. e., produced by a reflex action, due to the excitation of
sensitive nerves near the muscles attacked with cramp.

Romberg says that there are two kinds of aura epileptica ; a
sensitive and a muscular one. The sensitive consists of various
sensations, the muscular consists in a cramp (loco cit., p. 674).
This distinction is more apparent than real. If there are cases
where cramps are not reflex movements, depending upon the irritation
of a sensitive nerve, and in which they result from the direct excita-
tion of some parts of the nervous centres, such cases ought to be
distinguished from those where a cramp is connected with an aura
epileptica. Besides, when this connection exists, i. e., when either
a felt or an unfelt irritation of a sensitive nerve causes a local
cramp by a reflex action, before it produces the other phenomena
of a fit, the cramp is only apparently an aura.

In reality, there is only one kind of aura epileptica, if we leave
to this word the meaning which it has had for centuries, i. e., a
local sensation preceding a fit. This sensation in some cases ex-
ists without any cramp ; in other cases it seems to co-exist with a
cramp in the neighborhood of its starting-point.

In cases where the irritation of a sensitive nerve causes a fit
without being felt, there may exist a local cramp, but the name of
aura cannot be given to this cramp, as it is only the first reflex
manifestation of the preliminary irritation, the existence of which
may be found out by the means mentioned in § XI.

§ XIII. My experiments upon animals, compared with cases of
epilepsy observed in man, throw a great deal of light on what we
might call the physiology of epilepsy, that is, upon what concerns
the etiology, the seat, and what is vaguely called the nature of this
disease. It is easy to show that one or the other of the two se-
ries of facts we have to compare, if not both, are in opposition
with the various doctrines concerning the production and the seat
of epilepsy. A short critical examination of these doctrines will
prove the correctness of this assertion.

The time has passed away when men of talent were tempted to
place the seat of epilepsy in the pituitary body (Joseph Wenzel),
in the pineal gland (Greding), or in the spinal cord (Esquirol,

Reid). The injuries or organic alterations of these parts, as well as
of other parts of the nervous system, may be either the cause or an
effect of epilepsy, but none of these parts can be considered as the
essential seat of this affection. The numerous cases of co-existence
of epilepsy and of a disease of the pituitary body, related by Joseph
Wenzel ( Beohachtungenueher den Hirnanhang fallsiichtiger Per-
sonen. Edited by Carl "Wenzel, Mainz, 1810^, have lost their ap-
parent importance since it has been shown by Romberg (loco cit.,
p. 685) and others (Rokitansky, Engel and Sieveking, in Hand-
field Jones's and Sieveking's Manual of Pathological Anatomy,
1854, p. 267, Amer. Ed.) that the pituitary body may be altered
although epilepsy does not exist, and that this neurosis may exist
without any apparent alteration in this small organ. There is no
part of the nervous centres about which the same argument could
not be used.

Many writers have asserted that epilepsy must depend upon a
disease of the brain (organic or not), on account of the existence
of the cerebral symptoms. It is useless to speak of the authors
who have been or who still are unacquainted with the phenomena
of reflex actions ; I will merely refer for their views to the works
of Portal (loco cit., p. 143-155) and Delasiauve (loco cit., p. 27-
35). But many physicians of talent, knowing very well what re-
lates to the reflex actions, have considered the brain as the essen-
tial seat of epilepsy. Thus, this affection is placed among the
so-called cerebral convulsions by very able pathologists, such as
Romberg (loco cit.), Spiess {Krankhafte Stor. des Nervensy stems,
in Wagner's Handwdrterhuch der Physiol., vol. iii., 2d part,
1846, p. 188), Russell Reynolds (The Diagnosis of Diseases of
the Brain, Spinal Cord, Sfc, 1855, pp. 143 and 174), and others.
According to Dr. John Simon, " the intellectual changes which
precede, accompany or follow the progress of the disease, its con-
currence with insanity, and its tendency to dementia, further mark
the convoluted surface of the hemispheres as the primary seat of
the morbid process" (General Pathology, ^c, 1852, p. 152,
Amer. Ed.).

The modern physiologists agree in admitting that the brain pro-
per (the cerebral lobes) cannot give rise to convulsions when it is
irritated, in animals. Surgeons have sometimes had an opportu-
nity of ascertaining that, in man also, the brain may be cut with-
out producing convulsions. But these facts merely prove that

usually the brain proper cannot be excited by our means of exci-
tation. They do not prove that it cannot be irritated by other
kinds of irritation. The cerebral lobes, as being the seat of the
will, are certainly connected with muscles and can produce con-
tractions in them, as our voluntary movements constantly prove.
We think convulsions may result from kinds of irritation (as that
of a poison in the blood, for instance) different from those which
we usually employ in our experiments. On another side it may
be that alterations in the nutrition of the brain, and other causes,
produce a change in the vital properties of this organ, or rather
give it something that normally it does not possess, viz., the pro-
perty of causing convulsions when it is irritated. That such a
change in the vital powers of the cerebral lobes is possible, we
are led to admit, as we know that other parts of the nervous sys-
tem may acquire vital properties that they have not in their nor-
mal state. For instance, some parts of the sympathetic nerve
seem to be deprived of sensibility, but inflammation renders them
very sensitive ; the nerves of tendons seem to be without sensi-
bility, but inflammation renders them evidently sensitive, as
has been definitely proved by the Avell-devised experiments of
Prof. Flourcns [Comptes Rendus des Seances de VAcademie des
Sciences, 1856, vol. xliii., p. 639), I might give also as a striking
instance of a change in the vital properties of a part of the ner-
vous system, what occurs to the cutaneous ramifications of certain
branches of nerves in the face and neck, after an injury to the spi-
nal cord in animals.

I must now say that, although I admit the possibility of the pro-
duction of convulsions by an irritation of the cerebral lobes, I do
not think it is proved that these parts of the nervous system have
actually caused convulsions. The facts mentioned by Romberg
(loco ait., p. 625-27) do not furnish such a proof. They may be
explained by admitting that the convulsions depended upon either
an excitation of the sensitive nerves of the meninges, or upon
pressure on the parts of the encephalon which are known to be
excitable, or upon the disturbance of circulation and nutrition in the
excitable parts of the encephalon. The case of a child ( Pathol,
and Pract. Researches on Diseases of the Brain, by Abercrombie,
4th Edit., 1845, p. 57), upon whose anterior fontanelle pressure
determined convulsions, and the experiments of Portal (loco dt.,
p. 149), which gave similar results, cannot prove anything, because
5

pressure upon any part of the brain through a small opening in the
cranium, acts upon the whole of the encephalon.

Until it is proved that tho cerebral lobes have directly caused
convulsions, we are not entitled to say that the scat of epilepfc}
is in them. If it is argued that the brain proper must be the seai
of this affection because an idea or a remembrance, or a smell or
the sight of certain things, may induce a fit, we answer that thes<^'
causes of convulsions act in producing an emotion, and that emo-
tions have their seat in the pons varolii and the medulla oblonga-
ta, and not in the brain. If it is said that the loss of conscious-
ness implies that the cerebral lobes have something to do with
epilepsy, we certainly do not deny it ; but what is the relation be-
tween these lobes and epileptic fits ? How can convulsions, i. e.,
actions the existence of which imply that a great amount of ner-
vous power is employed — how can they be produced by an organ
which has lost its principal function ? How can this organ be so
active in the production of convulsions just at the time it loses its
activity as the organ of volition and perception ? How can we
admit that an organ assumes actions which it is not known to pos-
sess, at the same time that it loses its well-known actions ?

Those physicians who maintain that the brain is the primary or
essential seat of epilepsy, have too much neglected these difiicul-
ties and contradictions. Their only argument consists in saying
that it must be so because the brain is affected ; but we might
employ a similar argument to say that many other parts of the
nervous centres are the seats of ej^ilepsy because they are evi-
dently affected, and as much as the brain. It is interesting to re-
mark that it is just the same argument that Dr. Marshall Hall
employs to show that the seat of this affection is in what he calls
the true spinal cord. Such arguments in the end amount to simply
an assertion like the following : it is so, not because it is proved
to be so, or because the facts agree in allowing us to admit that it is
so, but because we cannot explain it otherwise. An argument of
this kind is never a decisive one ; but it has no value, and ought
not to be employed, when the facts are not explained by the hypo-
thesis considered as the only possible explanation, and still more
(as is the case with the supposition that the seat of epilepsy is
in the brain proper) when there are facts in opposition to the pro-
posed explanation.

We will try to show hereafter that the loss of consciousness in

epilepsy may be explained otherwise than by admitting that the
brain is the seat of this affection, and that the loss of conscious-
ness, whether it exists alone or with convulsions, may be due to an
action beo'innins; elsewhere than in the brain.

As resrards the state of the mind and of the senses after an at-
tack of epilepsy, it is not and cannot be a proof that the seat of
this disease is in the brain, as those disturbed states may result
from various circumstances existing during a fit.

We must now say a few words of a theory which pretends to
solve the difficulty above exposed, concerning the coincidence of
the loss of action of the brain and of an increased muscular ac-
tion. The estimable author of a singular but interesting work
( Epilepsy, and other affections of the nervous system ivhich are
marked by tremor, convulsion or spasm, ^c, 1854), Dr. C. B.
Radcliffe, in this book and in his lectures on Epilepsy (Medical
Times and Gazette, March and April, 1856), grounds an explana-
tion of this difficulty upon the supposed fact that muscular contrac-
tion does not depend upon a stimulus by the nervous system, but
upon the cessation of all stimulus. Dr. Radcliffe, after Duges and
others, thinks that muscular contraction is a purely physical phe-
nomenon, dependent on ordinary molecular attraction when the
muscle is not stimulated. If the muscles are at rest, it is because
an excitation comes upon them, preventing the molecular attrac-
tion from producing contraction. If a voluntary movement takes
place, it is because the will has suppressed the nervous action
which prevented contraction. In a fit of epilepsy, convulsions
take place, together with the loss of consciousness, because the
brain and other parts of the nervous centres l"ose their powers at
the same time, and stimuli being withdrawn from the muscles, they
are left to the action of molecular attraction, and therefore con-
vulsions are produced. It is useless to discuss a theory like this,
which is in opposition to almost all the known and the most posi-
tive facts of physiology and pathology. I will merely say that if
the theory were true, we should always see convulsions in para-
lyzed muscles, and also after death at the time when nerves lose
their power upon muscles.

According to another theory, which certainly deserves much
more attention than the preceding, epilepsy depends upon changes
taking place in the circulation of blood in the brain proper, and
in the other parts of the encephalon. The germ of this theory

may be found in the works of many writers, and particularly in
the remarkable book of Prichard ( A Treatise on Diseases of the
Nervous System, part 1st, 1822), but Henle has done so much for
it that he may be considered as its originator. In his admirable
work (Handhiich der Rationelle Pathologie, vol. ii., 1st part,
1855, 2d ed., p. 181-3 and p. 403; and 2d part, 1854, p. 46) he
tries to show that there are two kinds of epilepsy, one attended
with plethora, the other with anajraia. In both there is as a cause
of convulsions, a pressure by accumulated blood in the vessels of
the base of the encephalon. We may understand easily the con-
gestion of the brain in plethora, but it is not so as regards anae-
mia. Henle explains it in this last case, in admitting that when
ansemia goes on increasing, the bloodvessels of the upper parts of
the encephalon becoming empty, the others necessarily become
more filled, on account of the impossibility of the cranio-spinal
cavity containing less fluid (an impossibility well established
by Kellie, Abercrombie, J. Reid and others). As regards the loss
of consciousness, it is attributed to an excess of blood pressing
upon the brain proper, in plethoric epilepsy, and to the diminution
of blood in this organ, in anaemic epilepsy.

Although we think that many thanks are due to Henle for the
efforts he has made to show the relations between the phenomena
of epilepsy and the state of the blood-vessels of the various parts
of the encephalon, we cannot adopt his theory.

In the first place, if a congestion in the two distinct parts of
the encephalon (the brain proper and the basis of the encephalon)
was sufficient to produce epilepsy, this disease would be much
more frequent than it is, and we should not see so often hyperas-
mia of the encephalon without convulsive fits, and nevertheless pow-
erful enough to cause paralysis, delirium or coma. The great work
of Prof. Andral (Clinique Midicale, 4th ed., vol. v., 1840, p. 217-
292) and almost all the treatises on intermittent fever, and particu-
larly those of Bailly and Maillot, afford decisive proofs of the
frequency of cases of encephalic congestion without epilepsy.
Henle himself has been obliged to say that i7idividual disposition
is necessary for the production of this convulsive affection.

In the second place, we object to the theory of the learned Ger-
man physician, because he gives no proof that the mere mechani-
cal action (pressure) due to accumulated blood in the vessels of
the basis of the encephalon, is sufficient to produce convulsions.

In the third place, Henle does not give any clear reason why,
in the anjemic epilepsy, the bloodvessels of the brain proper con-
tract, while those of the basis do not; and besides, except con-
cerning lead disease, he does not say what excites contraction in
them.

Theories of epilepsy, entirely at variance with the preceding,
have been proposed. la the last century, Saillant {Expir. sur des
Animaux pour decouvrir le siege et la cause prochaine de I'epilepsie,
in Hist, de la iSoc. Roy ale de M^decine, in 1782 and 1783, p.
88-96), without giving a theory of epilepsy, concluded, from some
experiments, that it is easier to cause epileptic seizures in produc-
ing alterations in the blood than by irritating the nerves or the
brain. Had galvanism been known at the time of the researches
of Saillant, and had he employed it to irritate the nervous centres,
he would have seen much more violent and lasting convulsions than
those he observed after having altered the blood by injections of
air, &c. His experiments only show that convulsions may be due
to altered blood, a fact well known already before his researches.

One of the most eminent medical writers of our times, Dr. R.
B. Todd, has recently proposed a theory of epilepsy, which I must
discuss at length, on account of the importance it should have if it
were true, and of the value that belongs, necessarily, to any opin-
ion held by such an ingenious and experienced physician.

Dr. Todd says, " I hold that the peculiar features of an epileptic
seizure are due to the gradual accumulation of a morbid material
in the blood, until it reaches such an amount that it operates upon
the brain in, as it were, an explosive manner ; in other words, the
influence of this morbid matter, when in sufficient quantity, excites
a highly polarized state of the brain, or of certain parts of it, and
these discharge their nervous power upon certain other parts of
the cerebro-spinal centre, in such a way as to give rise to the phe-
nomena of the fit."

Dr. Todd then proceeds to say that a very analogous effect is
observed when strychnine is given to a cold-blooded animal. This
drug may be administered in very minute quantities for some time
without producing any sensible effect; but when the quantity has
accumulated in the system up to a certain point, then the smallest
increase of the dose will immediately give rise to the so-well-
known peculiar convulsive phenomena, observed in this kind of
poisoning. Dr. Todd adds : « This, then, is the humoral theory of

epilepsy. It assumes that the essential derangement of health
consists in the generation of a morbid matter, which affects the
blood, and it supposes that this morbid matter has a special affinity
for the brain or for certain parts of it, as the strychnine, in the
case just cited, exercises a special affinity for the spinal cord. The
source of this morbid matter is probably in the nervous system, it
may be in the brain itself. It may owe its origin to a disturbed
nutrition — an imperfect secondary assimilation of that organ — and
in its turn it will create additional disturbances in the functions
and the nutrition of the brain."

"According to the humoral theory, the variety in the nature and
severity of the fits depends on the quantity of the poisonous or
morbid material, and on the part of the brain which it chiefly or
primarily affects. If it affect primarily the hemispheres, and spend
itself, as it were, on them alone, you have only the epileptic verti-
go. If it affect primarily the region of the quadrigcminal bodies,
or if the affection of the hemispheres extend to that region, then
you have the epileptic fit fully developed." — [Medical Times and
Gazette, Aug. 5, 1854, p. 129.)

This theory is nothing but an ingenious hypothesis which Dr.
Todd proposes, without trying to prove it. The only reason he
adduces to support his theory is, that in the renal epilepsy there
is very likely a poison in the blood, but as regards the other kinds
of this convulsive affection, he does not say any thing which may
lead to the admittance of his hypothesis. Feeling that he had no
proof of the correctness of his views, he says : " To give a more
definite character to the humoral theory, we need to discover a
morbid matter in the blood, in variable proportions, in every case
of epilepsy. This desideratum has, as yet, been only partially ob-
tained." Dr. Todd alludes here to the influence of the accumula-
tion of urea in blood, in the cases of renal epilepsy. Leaving
aside, for a moment, this kind of epilepsy, we may say against the
humoral theory of the eminent British physician: 1st, That we do
not know any fact in favor of it ; 2d, That there are a great many
facts in opposition to it.

Not only we do not know any fact favorable to this theory, but
its author seems to be like ourself, in this respect, as he does
not relate a single one. We have never read or heard that a poi-
son produced in the brain, has been found in the blood of epilep-
tics, and we cannot imagine on what ground a fact of this kind is

considered as probable by the author of the humoral theory or
rather hypothesis.

To establish the humoral hypothesis on a solid basis, it would be
necessary to show : 1st, That there is always a poison in the blood
of all epileptics; 2d, That this poison gradually accumulates in
the blood until its quantity has become considerable enough to
produce the phenomena of the fit ; 3d, That during or after a fit,
this quantity diminishes (because if it were not so, the fit would
continue or come again and again, after a very short time) ; 4th,
That the nature of the poison varies, so that it acts either on the
brain proper alone (producing a mere vertigo), or on the other
parts of the cerebro-spinal centre alone, or on the whole of this
centre at once ; 5th, That this poison has quite a different influ-
ence on the brain proper and on the other parts of the cerebro-
spinal centre, destroying the actions of the former and increasing
excessively the actions of the latter.

Not only none of these points have been made out, but it seems
that no attempt has been made in the way of a demonstration in
this respect.

That there is a poison in the blood of epileptics is a fact which,
nevertheless, is possible, as there are substances in the blood of
every man, healthy or epileptic, which by a transformation or by
accumulation, may act as poisons, and be the cause of many of the
phenomena of an epileptic seizure; but it is not known whether
the quantity or quality of these substances is changed in epileptics,
just before the fits.

There are many facts which are in direct opposition with the
humoral theory of epilepsy. Certainly it is so for all the cases in
which a ligature around a limb or one of its parts, has prevented
a fit, and also for the cases in which epilepsy has been cured by
the section of a nerve, by an amputation, by the extirpation of a
tumor, a tooth or a foreign body, or by the expulsion of calculi,
of worms,* &c. If, in all these cases, there was, as the cause of the
phenomena of the seizure, a peculiar influence of some poisonous
matter on the encephalon, instead of an irritation springing from

* A curious case of hyslcro-epilcpsy, due to larvoe in the frontal sinuses, lias been recently pub-
lished by Messrs. Duminil and Legrand Dussaule. These larvse, which belonged to five different
species, were expelled by the nose, and after their expulsion the patient, who had had violent con-
vulsions for many months, was cured. (Sec the very useful report on the progress of medicine
and surgery, entitled Aimuaire dcs Sciences Midicales, par le Dr. Lorain, revu par le Dr. Ch.
To' V■^ '■•. \?''-. p. ISi )

-*».w. 48

certain peripheric nerves, the means mentioned would not prevent
the fits, and, still less, effect a complete cure of the disease. If we
were to admit that it is a poison which causes the phenomena of
the seizure in these cases, we should have to admit also that this
poison acts on the peripheric parts of some nerves, and not on the
encephalon. But there is no more ground for this last hypothesis
than for the preceding, because the presence of a poison in the
blood is a mere supposition. Besides, if this would be a reality
instead of a gratuitous supposition, it would remain to be explain-
ed why this poison does not act in some way or other after the
section of a nerve, or the extirpation of a tooth, &c.

The humoral theory is in opposition with many other facts,
among which are those proving that an emotion or various other
moral causes may produce a fit of epilepsy. For cases showing,
without any doubt, the influence of these causes and their relative
frequency, I will refer to the works of Delasiauve {Loc. cit., p.
219-22) and Moreau, de Tours (De Vetiol. de Vepil. et des indi-
cations, &c., in Mem. de VAcad. Imper. de Mddedne. 1854. Vol.
XVIII. p. 1 et seq.).

The facts we have related in § XI., to prove that seizures of
epilepsy are sometimes produced by a mere pressure upon or by
galvanization of a small part of the skin, are also in direct oppo-
sition to the humoral theory. How could a pressure upon the
skin produce a fit, every time it is made, if the fits were due
only to a peculiar influence of a poison on the encephalon ?

The following facts resemble, in many respects, those I have
mentioned in § XI., and they also are in complete opposition to
the humoral theory: they have been collected by Delasiauve (loco
cit., p. 137-38), to show the influence of certain circumstances
on some epileptics: 1. A patient could not smell hemp, without
having a fit. — (Tissot.) 2. In another, the same effect was pro-
duced by the slightest odor, even that of broth or of a medicine. —
(Schubart.) 3. A child had a fit every time he saw something
red. — ( Buchner, Tissot.) 4. A child had an epileptic seizure as
often as he heard a dog bark. — ( Van Swieten.) 5. The idea of
phantoms, which had frightened a boy, when quite young, was suffi-
cient to cause the fits. — (Maisonneuve.) 6. In a case, the re-
membrance of a fright was enough to produce the seizure. — ( Van
Swidten.) 7. Any word of blame, addressed to two patients;
gave them a fit. — ( Delasiauve.)

The cases iu wliicli a physical impression lias been the cause of
the first attack of epilepsy, may be regarded as less valuable
against the humoral hjqoothesis, than the preceding facts in 'which,
at each return of the cause (either moral or physical), a seizui'e
took place. It might be said to diminish their value that the phy-
sical impression occurred just at the time when the poison of the
blood was beginning to act upon the brain. But in admitting that
such a coincidence has sometimes taken place, "we certainly cannot
imagine that in all the very numerous cases of epilepsy, in which
the first fit has occurred immediately after a physical impression,
such a coincidence has existed. The works of the principal wri-
ters on epilepsy. Van Swieten, Tissot, Maisonneuve, Cooke, Esqui-
rol. Portal, Copland, Herpin, Delasiauve, Moreau (de Tours), &c.,
contain too many of such facts for our dreaming of the possibility
of explaining the production of epileptic fits, immediately after a
physical impression, without attributing at least a share in the
causation of these fits, to this impression. The post hoc, ergo
propter hoc, is a sound reasoning when the number of facts is so ex-
tremely considerable as it is here.

In my animals, as I have already said many times, the fits are
produced at every time the skin of certain parts of the neck and
face is pinched.* As the seizure in these animals takes place
wdien we desire it, we have there a decided proof that, at least in
them, fits may be produced otherwise than by the irritation of a
poison on the encephalon.

It results from this exposition of facts that, in animals and in
man, fits of epilepsy cannot be considered as always due to the in-
fluence of a poisonous matter upon the encephalon. We would
not say, however, that they are never caused by a poison in the
blood. It seems, on the contrary, not only when there is a defi-
ciency in the urinary secretion, but also when the elements of bile
arc in great quantity in the blood, or when the functions of the
supra-renal capsules are suppressed, that epileptiform seizures take
place, owing to the irritation that certain substances, contained in
the blood, exert upon some parts of the nervous system. When
there is not a free menstruation, and perhaps, also, when the secre-
tion of the skin is stopped, it seems probable that a poisonous

* In October, 1856, I bad the satisfaction of showing this cxiu'rimenl to Dr. R. B. Todd him-
•elf, in presence of mapy distinguished physicians, among whom were M. W. Bowman, Prof. L.
Bcalc, Dr. R. H. Semple and Dr. R. Druilt.

matter remains in the blood, where it accumulates, and that it par-
ticipates in the causation of epileptic fits.* Besides, it is certain
that some poisons, and particularly lead, are able to cause epilepsy.
But many questions are still to be solved, concerning the modus
operandi of poisons which cause convulsions. I have shown else-
where {Experimental Researches applied to Physiol, and Pathol.
New York, 1853, p. 57-63 and p. 113) that these poisons have
two modes of action, entirely different one from the other. One
of these modes, which is by far the most frequent, seems to con-
sist only in an increase of the reflex faculty of the cerebro-spinal
centre. The poisons which belong to this category, according to
my researches, are the following : strychnine, brucine, cyanhydric
acid, cyanide of mercury, morphine, nicotine, picrotoxine, digitaline,
sulphide of carbon, oxalic acid, &c. The other mode of action of
poisons producing convulsions, consists mostly in a direct irritation
of various parts of the nervous system. I do not know of any
other poison, acting exclusively in this way, except a substance ex-
isting normally in the blood, which accumulates during asphyxia,
and which very likely is carbonic acid. The differences between
these two modes of action of poisons are striking. In one of these
modes there is no irritation, or at least very little, produced upon
the nervous system or the contractile tissues, and therefore there
is no convulsion directly caused by the poisons belonging to this
category.

It will probably surprise many persons to hear that strychnine,
cyanhydric acid, brucine, &c., do not directly give convulsions —
but this is a fact j these substances do not seem to have any pow-
er of excitation either on muscles, on sensitive and motor nerves,
or even on the spinal cord. Perhaps some of the poisons, of
which a list is to be found above, have a slight power of excitation
on the spinal cord, but they certainly do not cause directly the pow-
erful convulsions which are attributed to them. They act almost
only in increasing the reflex power of the cerebro-spinal centre, in
such a manner that the least excitation, as, for instance, a volunta-
ry or a respiratory movement, or any other kind of irritation of
nerves of the skin or of the mucous membranes, causes convulsive

* Very judicious remarks on Ihe subject of the influence of poisonous matter contained in blood,
in eruptive diseases, in jaundice, in deranged menstruation, in albuminuria, &c., have been made
by Prof Gunning S. Bedford, in liis important work, Clinical Lectures on the Diseases of Wpineri
and Children. Third Ed. 1856. pp. 437, 475, 502 and 525-31.

reflex movements. "We might say that they act in giving to the
nervous centres the faculty of causing convulsions when the cen-
tres are irritated, but they do not irritate. (For the proofs of these
views, see my Avork above quoted, p. 57-63.) On the contrary,
black blood, or very likely carbonic acid, seems to destroy the re-
flex povrer of the cerebro-spinal centre, but while so acting, it
irritates violently this centre, and, therefore, causes directly pow-
erful convulsions. This last poison differs also from the preced-
ing in being able to irritate directly muscles and motor or sensi-
tive nerves. (See for this and other influences of black blood, or
rather of carbonic acid, my work, already qnoted, p. 110-13, and p.
117-24. See, also, the thesis of my friend and pupil. Dr. Brandt,
entitled Des phenomcnes de contraction obset^ves chez des indivi-
dus morts du cholera ou de la jiivre jaune, Paris, 1855, and my
paper on red and black blood in the London Medical Times and
Gazette, Nov. 17, 1855, p. 492-94.)

There are, therefore, some poisons that cause convulsions indi-
rectly, by increasing the reflex power of the cerebro-spinal centre,
and not in irritating them, while there are others which cause con-
vulsions directly by an irritation of the cerebro-spinal centre. In
which of these two categories are we to place the poisons, con-
tained in blood in cases of epilepsy, where some secretion (the
urinary, the biliary, &c.) is suppressed or much diminished ? This
is quite an undecided question. Many other things are still to be
known concerning these poisons ; but we do not intend to examine
this subject here. We wished merely to say, that even in cases
where there is some ground for the humoral theory of epilepsy,
proposed by Dr. Todd, we have no proof that the poison acts as
this eminent physician supposes. We will add that even in cases
of organic disease of the kidney, coincident with epilepsy, we are
not entitled to declare positively that it is in consequence of the
accumulation of some of the principles of urine in the blood, that
the fits are produced, as it might be that they result from an irri-
tation of the renal nerves, as it is the case when there are calculi
in the tubuli of the kidneys without a notable diminution of the
secretion of these glands. On another side it is very well known,
as Prevost and Dumas, Segalas, Tiedemann and Gmelin, Mitscher-
lich, Bernard and Barreswil, Stannius, Frerichs and myself have as-
certained many times, that after the extirpation of the kidneys,
i. e., when the urinary secretion is as much diminished as possible,

convulsions arc very rarely produced, and never violent. So that in
a case of epilepsy with renal disease, either the convulsions have no
relation whatever with the renal affection, or if they have a rela-
tion, it is either through the agency of the renal nerves, or in con-
sequence of a transformation of some element of the urine in the
blood, as these elements seem to be unable to cause convulsions.
It is mostly this last argument which has led Frerichs, in his veiy
interesting work on JJright's disease (Die Bright'sche Niereii-
krankheiten, Leipzig, 1852), to his so-much-debated theory of
uraemia.

As a general conclusion of our discussion of the humoral theory
of epilepsy, we will say: 1st, that even in the cases where there
is probably a poison in the blood, its relations with the production
of fits are not known. 2d, that we are not entitled to consider as
due to the elements of certain secretions, remaining in the blood,
the epileptic fits which may exist when the glands producing these
secretions are diseased. 3d, that there are a great many cases of
epilepsy in which the cause of the fit is not in the blood.

Normal blood contains substances which may act like poisons,
either after a change in their chemical composition or when their
quantity is increased. But very few of these deleterious sub-
stances cause convulsions, directly or indirectly; most of them
kill without producing phenomena resembling those of a real fit
of epilepsy. When the cutaneous perspiration is stopped, after
the skin has been covered with a layer of varnish, as in the
experiments of Fourcault, Magendie, Becquerel and Breschct,
the animal dies, without having epileptiform convulsions." There
is also normally in blood a deleterious principle, the accumulation
of which, during a fit of epilepsj^, must certainly be the cause of
greater violence in the convulsions tban there would be if the

* Concerning this subject, I liave made many experiments, the details of which will be found in
another paper. I will merely give here some of the principal results : 1. The glands of I he skin
in the higher animals, and probably in man also, eliminate a poison ; 2. These glands arc in many
respects analogous to the venom-glands of the toad, the salamander, and also die viper and rat-
tlesnake; 3. When these glands (in the higher animals as in the reptiles) are taken away, or ren-
dered unable to act, the poison that they normally eliminate accumulates in the blood, and usually
death occurs quickly ; 4. It is wrong, therefore, to say that the venom is not a poison for the ani-
mal that produces it ; 5. If it seems that the ralUesnako, for instance (and the same thing might
be said of the toad, the viper, &c.), is not poisoned by its own venom, this depends upon the fact
that when introduced inlo the blood by absorption, the poison is quickly eliminated by the venom-
glands j 6. When these glands have been extirpated, the animals are poisoned by Iheir awn
venom ; 7. The sweat of ihc dog seems to be much more poisonous for a rabbit than for a dog, and
vice versa.

quantity of tins poison did not increase ; we moan carbonic acid,
or else some otlicr substance which accumulates in the blood at the
same time with this acid. In this respect the theory of epilepsy
of which we have now to speak — that of Dr. Marshall Hall — has
some relation with the humoral theory of Dr. Todd.

According to Dr. Marshall Hall, epilepsy, when it begins to ex-
ist, depends upon an increase of the excito-motor power in what
he calls the true spinal cord. He thinks that after a great
number of fits, the reverse exists ; the patient is in a state of ex-
haustion, due to the loss of the excito-motor power which accom-
panies each seizure, while the re-production of this power is not
adequate to the loss. He acknowledges, however, that although
exhausted, the patient is then in a state of extreme susceptibility
to new fits. (See one of his latest publications; Apercu du Sys-
teme Spinal, Paris, 1855, p. 139-140.) Elsewhere, Dr. M. H.
says that an epileptic fit is an excessive excitement of the medul-
la oblongata, the centre of the reflex actions [loco cit., p. 115).
He thinks that the causes of inorganic epilepsy act either directly
or indirectly upon the nervous centres, so that the convulsions
may be direct or reflex [loco cit., p. 108). The true spinal cord
having no spontaneous action, and epilepsy depending upon this
nervous centre, the result is that this afi"ection consists only in ex-
cited actions, either direct or reflex. [Loco cit., p. 206.) Dr. M.
H. says, " A spasmodic afl"ection of the larynx has obviously much
to do in this disease, as well as in the crowing inspiration, or
croup-like convulsions of infants ; so much, indeed, that I doubt
whether convulsion could occur without closure of that organ."
( On the Diseases and Derangements- of the Nervous System,
1841, p. 327.) The eminent physiologist, however, seems to think
now that the closure of the larynx, i. e., laryngismus, though essen-
tial, is not the only cause of the convulsions of epilepsy. To com-
plete the exposition of his views, we must say that he feels much
embarrassed concerning the loss of consciousness. He seems in-
clined to attribute it to the obstacle to the return of venous blood
from the brain.

To sum up the views of this distinguished physician, we will
say, 1st, That he places the seat of epilepsy in the excitable part
of the cerebro-spinal axis, and more in the medulla oblongata than
elsewhere ; 2d, That he thinks there is an increased reflex power
in the beginning of the disease ; 3d, That he admits that the con-

vulsions arc the results of the asphyxia caused by tlic closure
of the larynx.

We do not think it worth while to discuss the views of Dr.
Marshall Hall ; a few remarks are sufficient to show that they do
not contain an acceptable theory of epilepsy. In the first place,
how can this affection at one period of its existence depend upon an
increase of the reflex power, and afterward persist, when, according
to Dr. Hall, the reflex power is diminished ? How can the intense
excitement of the medulla oblongata, in which he supposes that
epilepsy consists, explain the loss of consciousness which is so fre-
quent in this disease ? As there are cases of epileptic loss of con-
sciousness without contraction of the muscles of the neck, the ob-
stacle to the return of blood from the brain cannot be considered
as the cause of the cessation of action of the brain. Besides, how
can a cause of increased action of the medulla oblongata be a
cause of loss of action in the brain ?

But although Dr. Hall has not published an acceptable theory
of epilepsy, we think he has done much for it in calling attention
to the phenomena of laryngismus and trachelismus. We will show
hereafter that the state of asphyxia which depends mostly on la-
ryngismus in epilepsy is, in some respects, a more important fact
than Dr. Hall himself admitted.

§ XrV. We have tried, in the preceding part of this paper
(see § XHI.), to show the deficiencies of the principal theories of
epilepsy. We will now state our own views, but before doing
so, we wish to declare that we do not pretend to give here a com-
plete theory of epilepsy ; we will merely try to elucidate some
of the principal questions on this difficult subject.

I have ascertained upon my epileptic animals that the brain is
not essential to the production of epileptiform convulsions. After
I have taken away the brain proper, in one of these animals, I
find that I can produce a fit almost as easily as before the opera-
tion, by pinching the skin of the face and neck. The only differ-
ence is, that the fit is not so violent, in consequence of the loss of
blood. We find that still weaker convulsions may be caused by
pinching the face and neck, if, besides the cerebral lobes, we take
away the cerebellum, and even the whole of the basis of the cn-
cephalon, except the medulla oblongata and the pons Varolii.

From these experiments it results tliat, in my animals, epilepsy

has its seat in eitlier the pons Varolii, the medulla oblongata, or
the spinal cord, or in these three parts together. It is very pro-
bable that its seat is in the upper part of the spinal cord, in the
medulla oblongata, and the pons Varolii, where the roots of the
trigeminal and of the first spinal nerves have their origin. Ac-
cording to some experiments made by Eduard Weber and Dr. R.
B. Todd, the faculty of producing epileptiform convulsions does
not belong to the spinal cord. E. Weber (Art. Muskelhewegung,
p. 16, in Wagner's Handwdrterhuch der Physiol.) says, that the
application of an electro-magnetic current to the spinal cord of
frogs produces tetanic convulsions, while its application to the
medulla oblons-ata causes alternate contractions and relaxations,
as in epileptic fits. Dr. R. B. Todd (London Med. Gazette, May
11, 1849) states, that while the convulsions excited by the electro-
magnetic current passing through the spinal cord and medulla oblon-
gata are tetanic, the muscles being thrown into a state of fixed con-
traction, those which ensue when the current is transmitted through
the region of the meso-cephalon and corpora quadrigemina are epi-
leptic, being combined movements of alternate contraction and re-
laxation, flexion and extension, affecting the muscles of all the limbs,
of the trunk, and of the eyes, which roll about just as in epilepsy.
We have performed similar experiments upon rabbits and frogs,
which have given almost the same results. In rabbits, when the
cui'rent was passed through the pons Varolii and the tubercula
quadrigemina, there were alternate movements of flexion and ex-
tension, resembling those of epilepsy, but much more extensive.
When the current passed through the medulla oblongata, there
were tetanic movements of the anterior limbs, with epileptiform
convulsions of the posterior limbs ; sometimes the anterior limbs
also had epileptiform convulsions. When the current passed
through the spinal cord, a tetanic spasm was produced. We have
found that a state strongly resembling a fit of epilepsy exists
after a transversal section of the upper part of the medulla ob-
longata, which state continues to exist as long as the animal lives.
We must not, however, conclude from these experiments that the
seat of epilepsy is only and always in one or in all of these parts
— the tubercula quadrigemina, the pons Varolii and the medulla ob-
longata. Pressure upon these parts has often taken place in man
without causing epileptiform convulsions, or convulsions of any
kind. More than ten of the cases of organic diseases of the en-

ccplialon, collected b}' Abcrcrombie (Path, and Pract. Researches
on the Diseases of the Brain and Spinal Cord, 4th cd., 1845, p.
433-457), alibrd sufficient proof of this assertion. The results
of the experiments of Weber, of Dr. Todd, and of our own, are
certainly interesting, but they cannot lead to the conclusion that
the con\ailsions of epilepsy in man result constantly from some
affection of the quadrigeminal bodies (as Dr. Todd believes), or of
the pons Varolii and medulla oblongata. It must be remembered
that the experiments upon animals are made on healthy nervous
centres, and that disease changes the vital properties of these cen-
tres. Tetanus, or at least, tetanic convulsions, are sometimes due
to diseases of the encephalon, and we have shown already (see
§ X.) that the nature of the convulsions has not any constant rela-
tion with the parts of the cerebro-spinal axis (spinal coi'd or en-
cephalon), primarily diseased in epilepsy. We know that the
muscles animated by nerves arising from the encephalon, or by
nerves from the spinal cord, very often exhibit the same kind of
convulsions in epilepsy, in tetanus, in hydrophobia, in poisoning,
&c. Besides, in a great many epileptics, the first convulsions in an
attack are tonic (tetanic), and they are succeeded by clonic con-
vulsions, la other epileptics the fits are sometimes entirely teta-
nic, and more rarely, entirely clonic in the limbs. In certain
animals. Dr. Martin-Magron and myself have discovered (see my
Expei^irnental Researches applied to Physiology and Pathology,
New York, 1853, p. 20) that an irritation of the medulla oblonga-
ta caused by tearing out the facial nerve causes convulsions which
are partly tonic and partly clonic. Other irritations of the medulla
oblongata, of the upper part of the spinal cord, of the pons Varo-
lii and its peduncles, of the tubercula quadrigemina, of the audi-
tory nerve, &c., cause also tonic and clonic convulsions (see my
work just quoted, p. 18-23, and p. 99). These facts, and many
others, compared to the effects of galvanization, show positively that
different kinds of irritation produce different effects, and, there-
fore, we cannot conclude from the fact that epileptiform convul-
sions are produced by galvanic irritation of the pons Varolii or
other parts of the encephalon, that it is an irritation of these ner-
vous centres which causes epilepsy in man.

If we neglect the nature of the convulsions and take notice only
of the parts of the body where they first occur, we arrive at the con-
clusion that the seat of epilepsy is very variable. Usually, however,

the first spasmodic contractions occur in the muscles of the larynx,
of the neck, of the eyes, of the chest, of the face, and in the blood-
vessels of the brain proper, as we will show hereafter ; and as
these parts are animated by nerves coming from the encephalon
and from the upper parts of the spinal cord, it seems that the seat
of epilepsy is usually in some of these parts, if not in all. But
the seat of this disease may be in other parts of the spinal cord,
as seems to be proved by the production of the first spasmodic
contractions in one of the limbs, either the inferior or superior.
After the first spasms, all the muscles of the body may be attacked
with convulsions ; so that if we take notice of the loss of the ac-
tions of the brain proper, there is ground for thinking that the
seat of the disease is both in those parts of the cerebro-spinal
axis where reside the faculties of Perception and Volition, and in
those endowed with the reflex faculty j but this view is right only
in appearance. We have shown already (see § XIII.) that the loss
of perception and volition does not prove that epilepsy has its
seat in the brain proper ; we will try, in a moment, to show the
great probability that a contraction of the bloodvessels of the
brain proper, due to an irritation of their nerves in the spinal cord
and medulla oblongata, causes the loss of the cerebral faculties ;
and as regards the increase of the reflex faculty, we will show
that a partial and a local increase is suSicient for the production
of fits.

Are epileptic fits always the result of an excitation of the cere-
bro-spinal axis ? We think that it is so, but we consider it possi-
ble, however, that the excitation may arise from chemical and phy-
sical changes taking place in the elements of the nervous centres,
in consequence of bad nutrition and other causes. In this case it is
just the same thing as if an excitation was produced by a tumor, by
a poison in the blood, or by a nervous influence arising from some
irritated nerve, &c.

As physiology teaches that an irritation of the simple direct
motor side of the cerebro-spinal axis cannot cause general con-
vulsions, we are entitled to consider as reflex the convulsive move-
ments which result from direct excitations of the nervous centres,
as well as those which result from irritations coming from peri-
pheric nerve-fibres. The so-called centric and eccentric causes of
excitation of epileptic fits, both act on, or through the sensitive or
excito-motory side of the cerebro-spinal centres, and consequently
8

both act on tlic reflex faculty of those centres, so that they both
ought to be called reflex excitations.

We think epilepsy depends in a great measure on an increased
reflex excitability of certain parts of the cerebro-spinal axis. We
shall no longer speak of reflex faculty or reflex property, because
these words do not express what we mean. In all muscular and
nervous tissues we find two distinct properties; a property of
producing actions, the force of which may vary extremely, and a
property of receiving excitations, which we call excitability. One
of these two properties may be very strong, while the other is very
weak. Take, for instance, the muscles of cold-blooded animals;
when the temperature is very low, their excitability is not very
considerable, while their force of contraction is very great.
When the temperature is high, on the contrary, the least excita-
tion induces them to contract, but their contraction is without
force. Again, if we take an atrophied muscle, we find, sometimes,
that it may be excited to contract by a galvanic current too weak
to excite contractions in a healthy muscle, while if we apply a
strong stimulus to both, we find that the healthy muscle contracts
with much more force than the atrophied one. Many experiments,
which we will publish in another paper, have shown us that the re-
flex faculty of the cerebro-spinal axis is composed, as the muscular
contractility is, of two elementary vital properties, one of which
we call the reflex excitability , and the other the reflex force. The
cerebro-spinal axis may have a great reflex force, and very little
excitability. It may, on the contrary, have an excessive reflex ex-
citability with very little reflex force. In almost all epileptics, if not
in all, the reflex excitability is increased, while the reflex force is
rarely above, and often below its noi'mal degree. The reflex ex-
citability may not be much increased, and nevertheless be sufficient
for the production of the fit, when certain excitations exist. I have
found in my animals that there is not a great increase of the re-
flex excitability of the cerebro-spinal axis, except in a part of the
spinal cord which is separated from the rest, and has no share in
the fits. In several persons attacked with epilepsy, I have ascer-
tained that the excitations most capable of producing reflex move-
ments did not act more powerfully than in healtliy persons, al-
though the experiments were made a short time before a seizure,
that is, at a time when the reflex excitability ought to have been
at its highest degree. In a young girl, particularly, we have as-

certaiiied that tickling the sole of the foot, the axilla, the lips, &c.,
produced less reflex movements than usual, although she was then
expecting a fit, Avhich came on, in fact, about ten minutes afterward.
The researches made by Romberg and by Professor Hasse (sec
his admirable work : Ki'ankheiten des Nervenapparates, in Y ir-
chow's Handbuch der Pathologie, Vol. IV., Pai't 1st 1855, p.
254) on the production of reflex movements during fits of epilepsy,
cannot prove much against or in favor of the existence of a great
reflex excitability, or reflex force in epileptics, because if the ex-
periment be made in the beginning of the fit, it is almost impossi-
ble to know whether the convulsions result from the experimental
excitations, or are normal parts of the fit ; and if the experiment
is made at the end of the fit, the absence then of reflex move-
ments proves only that the fit has exhausted the vital properties of
the muscidar and nervous tissues. Hasse concludes, from his own
and from Romberg's experiments, that the greatest variety in
the energy of reflex phenomena exists during the fits of epilepsy.

"Whilst we admit that in epilepsy there is almost always, and
perhaps always, an increased reflex excitability, alone or together
with an increased reflex force, we admit also that there is, in a great
many cases of fits of epilepsy, a special kind of excitation, acting
on the nervous centres. There are, therefore, three distinct ele-
ments for the production of a fit.

1st. Increase of the /orce of the reflex property;

2d. Increase of the expitability of this property;

3d. An excitation of a special nature, or a very violent one.

Of these three elements, the last two are the most frequent,
and perhaps, as we have said, the first of these two is essential.
As regards the share of a special excitation in the causation of
epilepsy, the cases we have related of the cure of this disease by
the section of a nerve, by ligatures, &c., show how considerable
it may be. But in my animals, we have, in this respect, a better
illustration. When the nerves going to the parts of the face and
neck, by the irritation of which we are able to cause fits, are laid
bare, we find that their irritation does not produce convulsions.
If, in these animals, the fits depended only upon an increased re-
flex excitability of the parts of the nervous centres whence the
nerves originate, we should see convulsions follow when we irri-
tate the trunks of these nerves. As there are none, we must ad-
mit that when an irritation (and a slight one is often sufiicient) to

the cutaneous ramifications of tliese nerves in tlie skin causes a
fit, there is sometliing special in the nature of the excitation
springing from these cutaneous nerves. However, there is in my
epileptic animals, an increased degree of reflex excitability in the
cereLro-spiual axis, as we find, even after the section of the nerves
of the face and neck, that they have convulsions sooner, and last-
ing longer, than in a healthy animal, when we prevent them from
breathing for two or three minutes.

A slight increase of the reflex excitability is not usually sufficient
alone to cause fits, and such an increase, without epilepsy, often co-
exists with great weakness, as is the case in old people, in convales-
cents, and in persons who have lost a great deal of blood. In all
these cases, reflex movements take place easily under the influence
of emotions, fright, or even a sudden noise. Many excitable, though
healthy men and women have reflex spasms in the act of coition —
hence the name given to this act by Sennert, epilepsia hrevis.

It is very probable that the reflex excitability, or the reflex
force, of the nervous centres, or both, are extremely considerable in
those persons who have fits of epilepsy for the fii-st time, caused by a
slight blow, or some ordinary moral excitement.

We shall not examine what are the parts of the cerebro-spinal
axis in which there is an increase of reflex excitability, because
what we have said above of the seat of epilepsy shows what are
these parts, their seat being nothing but that of the increased re-
flex excitability, or, in other words, epilepsy consisting chiefly in
that increased excitability. If it were proved that epilepsy some-
times exists only because the force of the reflex property is in-
creased, its excitability being normal, we should have to admit
that the seat of epilepsy is in almost the whole length of the ce-
rebro-spinal axis, because, as we intend showing elsewhere, the
force of the reflex property increases or decreases everywhere at
the same time.

We must say, that although we admit that fits of epilepsy depend
ordinarily on an increased reflex excitability, frequently combined
with the existence of some special kind of irritation originating in
the skin, in the mucous membranes, &c., we admit a,s possible, that
without any increase of excitability, certain irritations on some
parts of the encephalon may produce fits of epilepsy. We well
know that the least puncture witli a needle or pin of the p7-occssus
cerebelli ad poniem, and, as I have found, of the auditory nerve.

and of certain parts of the medulla oblongata, in mammals, is suf-
ficient to produce fits of a peculiar kind of epileps}^, in which the
animal rotates around the longitudinal axis of its body, in conse-
quence of the convulsions. In man this kind of epilepsy has been
frequently observed, and as the phenomena are the same as in
animals (except as regards the duration of the fit, which in man is
short, while in animals it lasts usually as long as life), it may be
that the rotary convulsions have been produced, although there
was no increased reflex excitability, in man as it is in animals.

Many discussions have taken place among physicians concerning
the first phenomenon of a fit of epilepsy. We are, however, yet
to know which of the epileptic phenomena is most frequently the
first. Is it the paleness of the face, as Prof. Trousseau and others
believe ? Is it a spasm of the larynx, as was admitted by Dr.
Marshall Hall ? Or is it the loss of consciousness ? We think
there is no doubt that either of these phenomena maybe the first,
but we do not know which is most commonly the first. They usually
take place at the same time, and in some cases they may be en-
tirely missing, or exist only after other phenomena.

Among the most interesting of these ordinarily first phenome-
na, is the paleness of the face. Delasiauve (Loco cit., pp. 56, GO,
66 and 77), considers it as extremely frequent in all kinds of at-
tacks, from the simple slight absence of mind to the most com-
plete epileptic seizure. Trousseau and Bland Radcliife ( London
Medical Times and Gazette, March, 1856, p. 303-304), are in-
clined to consider it as a constant symptom, and also as the first
one. This paleness has not been explained. We consider it as a
most interesting symptom, as it leads to a very probable explana-
tion of the loss of consciousness in epilepsy. After Prof. Claude
Bernard had discovered that the section of the cervical sympa-
thetic nerve is followed by a dilatation of the bloodvessels of the
face, I found that when this nerve is irritated by galvanism there
is a contraction of these bloodvessels, and I explained the facts
discovered by the eminent French physiologist and by myself, by
considering the sympathetic as the motor nerve of the bloodves-
sels of the face. I found, also, that the branches of the sympa-
thetic nerve which animate the bloodvessels of the face, originate
from the spinal cord with the branches of the same nerve going to
the iris. (See my Exper. Researches in Physiol, and Pathol.,
1853, p. 9-10, and p. 75; and the Medical Examiner, k-ag., 1852,

p. 489.) The theory I then proposed has been almost universally
admitted. We liave in this theory an easy means of explanation
of the paleness of the face in epilepsy. When the excitation
takes place in the spinal cord and the basis of the cncephalon,
which gives rise to the fit, the nerve-fibres which go to the head
are irritated, and produce a contraction of its bloodvessels. Of
course this contraction expels the blood, and, in consequence, the
face becomes pale. Very often another effect, depending on the
nerve-fibres of the cervical sympathetic, is produced — the dilata-
tion of the pupil. But the reverse sometimes takes place — a con-
traction of the pupil occurring, instead of a dilatation. This last
phenomenon is easily explained by admitting that the excitation
in tlie nervous centres takes place near the origin of the third and
fifth pairs of nerves, and not of that of the cervical sympathetic, as
is the case when the pupil dilates. The paleness of the face, and
the dilatation of the pupil (when it exists), soon disappear, chiefly
in consequence of the obstacle to the venous circulation in the head,
and of the state of asphyxia. The cause of the obstacle to the
return of blood from the head is not only the contraction of the
muscles of the neck, as Dr. Marshall Hall seems to think, but also
in the state of the chest. Dr. Russell Reynolds (Diagnosis of
Diseases of the Brain, ^^c, 1855, p. 176) says that he has observ-
ed many cases in which the muscles of the neck were quite flaccid,
notwithstanding the darkness of the face, and the leaden hue of
the body generally.

Among one of the first symptoms of the fit, and as a cause of
the cry, there is a spasm of the laryngeal muscles, and a contrac-
tion of the expiratory muscles. This contracted state of the
chest acts on the heart so as to diminish the force of its beatings,
as is the case in the experiment of compressing the chest, made
by E. Weber and others, and it acts on the veins, in preventing
the circulation in them. Although compressed, and unable to beat
freely, the heart quickly recovers an apparently great strength;
the blood, losing its oxygen and becoming black, acts as a power-
ful irritant upon the central organ of circulation, so that palpita-
tions, sometimes very violent, occur. Nevertheless, the pulse often
remains weak, because the quantity of blood scut to tlie arteries
by the heart is smaller than usual, partly on account of the obstacle
to the venous circulation.

We think that at nearly the same time, when the origin of the

branches of tlic sympcathetic nerve going to the bloodvessels of the
face receive an irritation in the beginning of a fit of epilepsy, the
origin of the branches of the same and of other nerves, going to the
bloodvessels of the brain proper, also receive an irritation. A
contraction then occurs in these bloodvessels, and particularly
in the small arteries. This contraction expelling the blood, the
brain proper loses at once its functions, just as it does in a com-
plete syncope. Now, as it has been well proved by the researches
of Kellie, of Abercrombie, of John Reid, of Henle and of Foltz,
that the quantity of liquid in the cranio-spinal cavity cannot change
suddenly, it results, that if there is less blood in the brain proper
there must be more in the basis of the encephalon and in the spi-
nal cord. In consequence of the impediment to respiration, the
blood sent to the encephalon, as well as to other parts of the
body, contains but little oxygen, and is charged with carbonic acid,
so that the large quantity of blood accumulated in the basis of the
encephalon (the medulla oblongata, the pons Varolii, the tubercu-
la quadrigemina, &c.), and in the spinal cord, is endowed in a high
degree with the power which I have shown that such blood pos-
sesses, i. e., to excite convulsions. It may be, as Henle has sup-
posed, that the basis of the encephalon is also excited to cause
convulsions in consequence of the pressure exerted upon it by the
accumulation of blood. The spinal cord, also, in all its length, is
then excited to produce convulsions by the blood which circulates
in it. The grounds on which I base these views are the following.

1st. There is, in the beginning of a complete fit of epilepsj^, an
irritation of the parts of the nervous centres from which originate
the nerve-fibres of the bloodvessels of the brain, and therefore
there ought to be a contraction of these vessels. The cervical
sympathetic nerve contains not only the nerve-fibres which cause a
dilatation of the pupil, and those which produce the contraction of
the bloodvessels of the face in the beginning of a fit, but also the
nerve-fibres of the bloodvessels of the brain. Prof Claude Ber-
nard (Memoires de la Soc. de Biologic, for 1853, p. 94j has found
that when the cervical sympathetic nerve is divided on one side,
the temperature of the brain is increased in the corresponding-
side. We have shown that tiiis elevation of temperature depends
upon the circulation of a larger amount of blood, which is the con-
sequence of tlic paralysis of the bloodvessels, due to the section
of their nerve-fibres. Some experiments of Donders, and of his

pupil, Van dor Bekc Callenfells, have also shown the influence of the
s^'uipathctic on the arteries of the pia mater (sec Bonders' Phy-
siologie des Menschen, Leipzig, 185G, p. 138 and 140); they have
seen these arteries contract when the sympathetic was irritated.

2d. We have said that we consider as reflex the convulsions of
epilepsy, whether they depend on centric or eccentric excitations.
The contractions of the bloodvessels of the brain and face in a fit
of epilepsy are also reflex. We have proved elsewhere (see my
Exper. Researches in Physiol, and Pathol., 1853, p. 34) that
bloodvessels may contract by a reflex action, as well as muscles.
In experiments with our distinguished friend Dr. Tholozan, Pro-
fessor at the Military Medical School of Paris, we have found that
the bloodvessels of one hand contract, by a reflex action, when
the sensitive nerves of the other hand were irritated by being ex-
posed to the influence of water at the freezing point. Schiff
(Comptes Rendus de VAcad. des Sciences, yo\. xxxix., 1854, p.
509), Donders (loc cit., p. 139), myself, and more recently M.
Yulpian ( Gaz. Med. de Paris, 1857, p. 18), have found that the
bloodvessels of the ear in rabbits contract by reflex action, when
the central part of the divided auricular nerve is irritated. I have
found, besides, that the splanchnic nerves and other branches of
the sympathetic have a reflex action on the bloodvessels of
the heart. (See my paper, Recherches Expcrim. sur la Physiol, et
la Pathol, des Capsules surrenales, 1856, p. 30.) All these facts
establish beyond doubt that the bloodvessels, as well as the muscles
of animal life, may contract by a reflex action. In a seizure of epi-
lepsy, therefore, the bloodvessels of the brain proper, those of
the face, the muscles of the neck, of the larynx, &c., may contract
by a reflex action, either separately or at the same time.

3d. To say that an explanation is a good one because we do
not know or because we cannot imagine any other one, is an argu-
ment which rarely has any value ; but Avhen the explanation is not
only possible, but is even rendered very probable, as is the case with
our theory of the loss of consciousness in epilepsy, it is an argu-
ment of a positive value that no other theory (except one or two
having many facts against them), has been proposed heretofore.

4th. It might be objected to the explanation wo propose, that the
loss of consciousness is too rapid to be due to a contraction of
bloodvessels. There is a fact which answers peremptorily this objec-
tion ; it is, that when the cervical sympathetic is irritated by a

po-werful electro-magnetic current, tlie contraction of the blood-
vessels of the face, and particularly of those of the ear, is almost
immediate, and so considerable that many of the small arteries
seem to expel completely their contents. Now, as everybody
knows that even a diminution in the supply of blood to the head,
as in ordinary syncope, is sufficient to produce an immediate loss
of consciousness, a fortiori is it so if the nerve-fibres, irritated in
the nervous centres, produce a contraction in the bloodvessels of
the brain proper.

5th. As we see that the bloodvessels of the face, after a con-
traction of very short duration, dilate and become turgid, it might be
asked if it be not so with the bloodvessels of the brain proper, and
why, in that case, there is no return of consciousness when the blood
returns in the dilating bloodvessels. We answer that it is probable
that the cerebral bloodvessels dilate, like those of the face ; but that
when this dilatation takes place, the blood which then reaches the
brain does not contain oxygen enough, and is charged with too
much carbonic acid, to be able to regenerate the lost function of
this organ. It is only when the respiration has become almost
completely free, that the functions of the brain re-appear.

6th. It might be objected, also, that the theory does not explain
why the nerve-fibres going to the bloodvessels of the brain pro-
per are excited, while those of the bloodvessels of the base of the
encephalon are not. The theory has not to explain this differ-
ence; it is a fact that the action of the brain proper is lost, while
the action of the basis of the encephalon is very much increased,
during a fit of epilepsy; and all that the theory has to do is to
explain the loss of action in one part, and the cause of increased
action in another. However, we may add that if the bloodvessels
of the base of the encephalon are not excited to contract, it is, ac-
cording to all probability, because their nerves originate in another
place from those of the cerebral bloodvessels ; and as we know
that the nerves going to certain muscles are excited in the begin-
ning of a fit, while others are not, we may understand easily that
the same thing exists for the nerves of the various encephalic
bloodvessels.

7th. As regards the influence of blood charged with carbonic
acid on the nervous centres, we will refer to our often-quoted
work (p. 80, and p. 101-124) ; and we will merely say here that
we have found that the injection of blood charged with carbonic

acid into the carotid or into the vertebral arteries, at once causes
epileptiform convulsions.

8th. It might be objected that the bloodvessels of the base of
the encephalon and of the spinal cord ought to be excited to
contract by two causes after the fit has lasted some time ; the
first cause being the excitation of all the parts of the cerebro-
spinal axis in which there is blood charged with carbonic acid,
and, consequently, the excitation of the nerves of the blood-
vessels of the basis of the encephalon, because these nerves
take their origin somewhere in those excited parts of the cere-
bro-spinal axis; the second cause being the direct excitation
of the smooth muscular fibres of the bloodvessels of the encepha-
lon by the blood charged with carbonic acid. Now if the blood-
vessels contract, whether it is on account of the first or of the
second cause, or of both, it seems that the fit ought to be diminish-
ed at once. But in the first place, it is probable that the blood-
vessels contract irregularly, some at one time, some at another.
In the second place, blood charged with carbonic acid, after its
first action (which is an excitation) has a secondary action, which
causes the loss of the contractility of the muscular layer of the
bloodvessels. In the third place, the obstacle to the return of ve-
nous blood may cause the bloodvessels to dilate to such an extent
that they cannot contract, as is the case with the heart when its
cavities are too full.

9th. If there are contractions in the bloodvessels of the brain
proper, as there are in the muscles of animal life, in the beginning of
an epileptic seizure, it is very easy to explain the variety of sen-
sorial and other cerebral symptoms of epilejpsy. In the same way
as there are certain muscles that contract in the neck, in the larynx,
or elsewhere, we may admit that there are certain bloodvessels
that contract either in some parts of the brain proper, or in the
nervous portions of the organs of sense, and in consequence, there
is a trouble or loss of either one or several senses, or of the in-
tellectual faculties, consciousness remaining more or less entire ; or
there is a successive loss of sight, of hearing, of the intellectual
faculties, and, at last, of consciousness.

10th. It is well known that sometimes the compression of the
carotid arteries stops a fit of epilepsy. Cases of this kind have
been mentioned by Liston, Earle, Albers, &c. The same operation
in certain animalsi, and particularly in rabbits in good health, is

sometimes sufficient to cause convulsions, so that we are led to tlie
question, How can the same circumstance in one case cause con-
vulsions, and in another diminish or destroy them ? My theory
may give an explanation of this apparent opposition. Changes in
the quantity of fluid in tlie cranio-spinal cavity cannot take place
suddenly, and if there is a considerable diminution in the quantity
of blood which enters this cavity, as is the case when the carotid
arteries are compressed, there is necessarily a corresponding di-
minution in the quantity that goes out. The blood which reaches
the encephalon by the vertebral arteries having to fill "a much
larger space, circulates more slowly and becomes much more charg-
ed with carbonic acid, and, besides, furnishes much less oxygen to
the encephalon, so that if the compression of the carotid arteries
be made in healthy animals, it causes convulsions, just as I have
found that blood much charged with this acid injected into the ca-
rotid arteries, causes convulsions ; whereas, if the compression of
these arteries be made in man, during an epileptic seizure, there
is at first usually a momentary increase in the intensity of the fit,
and sometimes after one or two minutes, i-arely sooner, a diminu-
tion in the violence of the convulsions, and in some cases, a complete
cessation of these contractions. Those who have observed what
takes place in animals when they are asphyxiated, have remarked
that after violent convulsive struggles, while the blood is becoming
more and more charged with carbonic acid, there is a diminution of
the convulsions, and at last nothing but rare respiratory efforts-
Carbonic acid, after having excited the vital properties of the ner-
vous system, seems to destroy them gradually, allovnng for a time,
however, the production of respiratory movements. The compres-
sion of the carotid arteries in epileptics, during a fit, induces a state
of asphyxia greater than that already existing, and in so doing,
diminishes the vital properties so much that there are no more
convulsions. Eespiration taking place* then, and the bloodvessels
of the brain proper relaxing, the whole encephalon receives more
oxygenated blood, and the patient recovers in the same way, and
by the same means, that he does when the compression of the ca-
rotid is not employed in a fit.

* Of all the reflex phenomena, the regular inspiratory and expiratory movements are those which
last the longest ; it is so during agony resulting from any disease, it is so after chloroform or ether
have been inhaled in large doses, it is so in asphyxia by hanging, drowning, &r., and it is so also
in epilepsy.

The theory of epilepsy that we have arrived at from the examina-
tion of the phenomena of this disease, is not in opposition with any
that we know ; and, still more, we might easily show that it is in
harmony with the most important facts concerning the causes, the
variations of the symptoms, the consequences and the treatment of
this convulsive affection. We will merely point out, in addition to
what we have related above, that the production of epilepsy by
lead (which is an excitant of contraction in bloodvessels), by loss
of blood, &c., and the important relations of epilepsy with inter-
mittent fever, are facts in perfect harmony with our theory.

We must now say a few words, 1st, on the production of the
change in the cerebro-spinal axis, which chiefly constitutes epilep-
sy (i. e., the augmentation of the reflex excitability) ; 2d, on the
production of the change of certain parts of the skin, mucous mem-
brane, &c., which renders these parts capable of exciting epileptic
seizures ; 3d, on the mode of production of a fit of epilepsy from
excitations springing either from a peripheric part or a central part
of the nervous system ; 4th, on the consequences of an epileptic
seizure, and on the inter-paroxysmal state.

1st. The production of a change in the reflex excitability of the
cerebro-spinal axis we think may take place in two different ways,
one of which is a direct abnormal nutrition, as in syphilitic, scrofulous
or rheumatic epilepsy, while the other is an indirect abnormal nutri-
tion, due to some excitation from a peripheric or a central part of
the nervous system. The modus operandi of such excitations we
do not know positively, but very likely, in a number of cases, at
least, it is through the bloodvessels of the cerebro-spinal axis
that these excitations operate to change the nutrition of this ner-
vous axis. We have ascertained that many substances which act
upon the spinal cord, either in increasing its reflex faculty (such
are strychnia, morphia, &c.), or in diminishing it (such are bella-
donna, ergot of rye, &c.), produce their effect chiefly by their in-
fluence on the bloodvessels of this nervous centre. When they
excite the bloodvessels to contract, they diminish nutrition, and
cause paralysis ; when they diminish the contractility of the blood-
vessels, and therefore allow them to dilate, there is more blood
in the spinal cord, and its nutrition is increased. Then the reflex
faculty becomes greater, and irritations may cause convulsions.
In animals and men, not having taken any of these substances, the
reflex excitability of the cerebro-spinal axis may be increased in

the following ways. An excitation on some part of the nervous
system causes a contraction of the small bloodvessels of a part of
the cerebro-spinal axis, and as the same quantity of blood still ar-
rives by the various arteries in the cerebro-spinal cavity, it results
that if the small ramifications of some arterial branches are con-
tracted, the others receive more blood, so that nutrition, and, in
consequence, the reflex excitability, augment in the parts to which
they are distributed. But this is not likely to be the most frequent
mode of increase of nutrition. "We have found that when a vascu-
lar nerve is excited for a long while, the contraction of the blood-
vessels after a certain time ceases, and a dilatation takes place,
which lasts longer than the contraction, although the nerve is still
excited : this is a paralysis by excess of action. In the nervous
centres, very likely this paralysis of the bloodvessels supervenes
also after considerable contractions, and in consequence pf this
paralysis, nutrition is increased in the parts of these centres where
it exists, as we have found that nutrition is increased in the nerves and
muscles of the face, when their bloodvessels are paralyzed. With
the increase of nutrition in the nervous centres comes the augmen-
tation of the reflex excitability, which seems to be the principal
element of epilepsy.

Besides these causes, there is another of greater importance,
which may exist when they do not : the nerve-fibres animating the
bloodvessels of the parts of the cerebro-spinal axis where epilepsy
has its seat, may be paralyzed, as the nerve-fibres of the muscles
of animal life are, by a disease of some part of the nervous centres,
and the consequence of this paralysis is necessarily an increase of
nutrition and of reflex excitability. This is a fact which we have
positively ascertained ; the section of a lateral half of either the
medulla oblongata or the spinal cord is the cause of paralysis of
the bloodvessels of the cord on the same side, the consequence of
which paralysis is that nutrition and the reflex excitability of the
cord become much increased. When the spinal cord is cut across
entirely, in mammals as well as in cold-blooded animals, the part
separated from the encephalon has its bloodvessels paralyzed, and
therefore dilated. Nutrition and the reflex excitability are soon
much increased in this part, and it is sufficient to touch the skin or
the mucous membrane of the genital organs, or of the anus, to de-

termine violent spasms.-^ This cause of production of epilepsy,
or at least of an increased reflex excitability, must exist in a very
great degree' in cases of tumors of the pons Varolii, or of the me-
dulla oblongata, and if they do not cause this convulsive affection
more often it is very probably because the moral and the emotional
excitation of fits cannot act in many of these cases.

When an excitation coming from some peripheric nerve produces
in the cerebro-spinal axis the change of nutrition which causes epi-
lepsy, it is very likely that this excitation sometimes, if not always,
acts otherwise than by producing a contraction of some bloodves-
sels. Whether this action is like those due to electricity or not,
we cannot tell, but we think that an opinion which we had held for
many years with Bonders, and some other physiologists,! must be
modified. This opinion is that all the nervous influences on nutri-
tion, secretion, &c., either direct or by reflex action, act only in
causing contractions or paralytic dilatations of bloodvessels. This
view, which has been criticised with much ability by Prof. James
Paget, in his admirable lectures on nutrition and on inflammation,
seems to have been proved to be too absolute by the important
researches of Prof. Ludwig and his pupils ( see Physiol, des Men-
schen, von Bonders, vol. i., p. 187-9, 1856), which appear to es-
tablish positively that there is another mode of influence of the
nervous system, at least on certain glands ; an influence resembling
that possessed by electricity in causing chemical combinations or
decompositions.:!:

2d. The changes produced in peripheric parts, rendering them
able to excite fits of epilepsy, consist more in alterations in the

* The same thing sometimes occurs in man. In a case of fracture of the spine, recorded by Dr.
Knapp (N. Y. Journal of Medicine, Sept., 1851, p. 198), there was paralysis of the abdominal
limbs. A month after the accident, (here were slight spasms in those limbs; in four months, the
spasms became violent; on exposure to the cold air, or to a sudden touch, the muscles were thrown
into the most violent agitation.

t Prof Claude Bernard, in announcing recently his important discovery of the substance which
in the liver gives origin to sugar, expresses himself very strongly in favor of this opinion. ( Gaz.
Mid. de Paris, 1857, p. 202.)

i We still maintain, however, as we have done for many years, that the influence of the ner^'ous
system on nutrition and secretion, either direct or reflex, is in a great measure due to the influence
of nerves on the muscular layer of the bloodvessels. Even galvanism, in improving nutrition, wc
have proved to act partly in this way ; it contracts the bloodvessels, and in so doing diminishes
circulation and warmth. But after a certain lime of violent coniraction, the bloodvessels become
paralyzed and dilated, so that more blood passes through them, and the temperature and nutrition
are increased.

nature of the excitations that may spring from peripheric nerves
than from an increase in the felt excitations coming from these
nerves. We have shown already that in our animals the skin is
nolymore sensitive in the parts of the face which are capable of
exciting fits than in the other parts of the face which have not that
power (see § IV,). In man, as we have also shown elsewhere (see
§ XI.), it is to the nature of the excitation, and not to the degree
of the pain, springing from some peripheric nerve, that we must
attribute the production of the fits. The fact that excitations,
starting from the periphery and causing fits, may not be felt, and
the fact that when there are sensations accompanying these unfelt
excitations, they may vary as to their kind, and sometimes be very
feeble, certainly are important arguments to show that the
real exciting cause, of the fit is something which is not felt. If the
term aura epileptica had not been employed already to express the
sensations which accompany the excitation of the fits, it would be
well to employ it to name the unfelt excitation which is the real
exciting cause.

In inquiring into the nature of the unfelt aura, we find that very
probably it is nothing but a violent excitation originating in the
excito-motory nerve-fibres. Dr. Marshall Hall and Mr. Grainger
have long ago imagined that there are nerve-fibres which are employ-
ed in reflex actions, and not in sensations and in voluntary move-
ments ; but they did not adduce direct facts to prove the correct-
ness of their views. I have found many facts which seem to give
the proofs hitherto needed that there are nerve-fibres which are em-
ployed in exciting reflex actions, and which are neither sensitive
nor capable of transmitting sensitive impressions to the encepha-
lon. I have found also, that the excito-motory power, like the sen-
sibility of nerves, varies in difi"erent parts of their length (see my
Experimental Researches applied to Physiology and Pathology^
New York, 1853, p. 98), and also in the same part, according to
various circumstances.

Besides, I have ascertained that in certain parts where the excito-
motory power seems not to exist, it may be generated, and become
considerable. Now, as the fibres which have this power seem not
to be sensitive, we understand why an excitation may originate
from them, reach the nervous centres, produce the loss of con-
sciousness and convulsions by a reflex action, without giving pain,
or even any sensation. We may understand also that this reflex

excitation may produce cramps by a reflex action in the muscles
which are in the neigliborhood of the starting point of the excita-
tion, which cramps give rise to a pain wrongly considered as a
primitive aura, although it is only a secondary and almost ineffi-
cient one.

With the view that in the very beginning of epileptic fits, caused
by excitations coming from peripheric nerves, it is not the sensi-
tive nerve-fibres, but only the cxcito-motory fibres which are in ac-
tion, we can easily explain many facts. For instance, in my ani-
mals, the power of giving rise to fits, belonging to the cutaneous
ramifications of nerves and not to their branches or trunks ; in
man, the absence of sensations, although there is an excitation
from some peripheric nerves, as in the case of M. Pontier (see
§ IX., Case VII., and many others mentioned in § XI.).

What the causes of the increase of the excito-motory power
are, we cannot tell positively. We know, however, that some
causes increase all the vital properties of nerves everywhere, and
among these causes we will point out a paralysis of the blood-
vessels, or the development of inflammation. But there are other
causes of which we are ignorant ; in my animals, for instance, there
is but a' slight increase in the vascularization of the part of the
skin which has the power of giving ris6 to fits, and this might be
due to the pinching employed to irritate the skin.*

The changes taking place in the peripheric nerves, either in the
skin, in the mucous membranes or in their trunks, when they be-
come able to excite epileptic fits, may be produced by the influence
of distant parts. For instance, in my animals, alterations of the
spinal cord as low down as the cauda equina have sometimes been
productive of the peculiar change in the face and neck which ren-
ders these parts able to excite fits. In man, tumors of the brain
seem to have produced a similar change in one arm.

In my animals I cannot decide whether it is through some direct
nervous influence upon the nutrition of the skin of the face and
neck, or if it is through an indirect influence, and by means of the
bloodvessels, that the spinal cord acts on this part. I have found

* I had said, in a paper read last year at the Academic des Sciences of Paris {Arch. Gin. dc
Mdd., F6v., 1856), that in making the autopsy of my epileptic animals, a congestion of the base
of the encephalon and of (he Gasserian ganglion is found ; but I have ascertained since that in a
great measure this congestion is a result of the fits and of the irritation of the skin of the face by
pincliing or otherwise, and not a circumstance preceding the first fit, and connected with the pro-
duction of the increase of the cxcito-motory power of the skin.

that changes in nutrition occur in other parts of the head — such as
the cornea — in animals upon which the section of a lateral half of
the spinal cord has been made, but is this a direct or an indirect
influence ? I cannot decide. It is very well 'known that the sym-
pathetic nerve in the abdomen may influence the nutrition of the
eye through the spinal cord, but does the influence result from a
change in the calibre of the bloodvessels of the eye, or is it a di-
rect influence, like that of certain nerves on the salivary glands,
according to the great discovery of Ludwig ?

As regards tumors of the brain, the important case of Odier
(see § VIIL, Case I.) seems to show that they may produce in the
arm that peculiar change in peripheric nerves which renders them
able to excite fits of epilepsy. But it is by far much more proba-
ble tliat it was not by an action of the brain, but through the irri-
tation of the sensitive or escito-motory nerves of the scalp, or in
consequence of the compression of the base of the encephalon,
that the change of nutrition took place in the arm.

3d. In the two preceding sections I have examined how arc pro-
duced the two organic causes of epilepsy ; i. e., the increase of the
reflex excitability of cettain parts of the cerebro-spinal axis, and
the increase in the excito-motory power of the peripheric nerves.
I have now to say a few words on the mode of production of the
most interesting phenomena of a complete fit of epilepsy.

The first phenomenon of such a fit is not always the same, and
this explains why the best observers do not agree in this respect.
Dr. Marshall Hall for a long while considered as the first symptom
a distortion of the eye-balls and of the features, and he admitted
as the second phenomenon a forcible closure of the larynx, and an
expiratory effort (Diseases and Derangements of the Nervous
System, 1841, p. 323). In many subsequent publications (see
Lancet, June 12, 1847, p. 611, and Apergu du Systeme Spinal,
1855, p. 101) he seems to consider as the first phenomena the con-
tractions of the muscles of the neck and of the larynx. Dr. C.
J. B. Williams (General Pathology, 2d Am. Ed., p. 166) says
that the first phenomenon is a palpitation of the heart. Herpin
(Loco cit., p. 421-5) after having tried to show that when there is
an aura the first phenomenon consists in a local cramp, says that
the second phenomenon (the first when there is no aura) is the epi-
leptic cry. According to Bean ("Jrc/i. Gin. de Mcc/., iSoG, p.
339), Delasiauve ('Z/Oco p. 65) and Hasse (Krankheiten des

Nervenapparates, 1855, p. 251), the epileptic cry, in tlie most com-
plete cases of epilepsy, may not exist. I have witnessed two fits
of epilepsy in which the most violent convulsions and a complete
loss of consciousness, followed by coma, took place without cries.
Is the loss of consciousness the first symptom ? Most of the prin-
cipal writers, who ignore the power of the reflex actions, consider
the cry as a proof of feeling: surprise, according to Beau; sur-
prise and pain, according to Herpin (Loco cit., p. 477) j surprise,
convulsion and pain, according to Delasiauvc (Loco cit., p. 77), and
they admit, therefore, that the loss of consciousness is not the
first symptom, at least in most cases. Billed attributes the cry to
the convulsive spasm of the laryngeal muscles, and to a convul-
sive expiration (Annales Med. Psychol., Nov. 1843). According
to him, the loss of consciousness precedes the cry, which is not a
symptom of surprise or of pain. Hasse considers the cry as being
probably the result of a reflex action (Loco cit., p. 251-2). I have
tried to show elsewhere ( Exper. Researches applied to Physiol,
and Pathol., New York, 1853, p. 54-5) that cries in animals or in
children deprived of their braiu, may be due to a mere reflex ac-
tion; the vocal cords being contracted, and the expiratory mus-
cles expelling quickly the air contained in the chest, the sound
which we call 'a cry is produced. In epilepsy, the loss of con-
sciousness, which is equivalent to the loss of the brain, allows a cry
to take place by reflex action. In the most complete and violent fits
of epilepsy, we think that the first phenomena are almost always,
1st, the contraction of the bloodvessels of the face, which causes
the paleness, noted particularly by Prof. Trousseau, by Delasiauve
and by Dr. Bland Radcliffe ; 2d, the contraction of the bloodves-
sels of the brain proper, which causes the loss of consciousness.
The cry, either at the same time, or immediately after, is produced
by the spasmodic contraction of the expiratory muscles, driving
the air forcibly through a contracted glottis. At the same time,
also, almost always some muscles of the face, of the eye and of
the neck contract. Sometimes, also, the spasm extends at once to
the muscles of the upper limbs, and afterward to the whole body.
All these phenomena are sometimes produced at once, and all are
the results of an excitation springing from some part of the exci-
to-niotory side of the nervous system. In other cases there is an
eviden't succession in these phenomena; the paleness of the face
and the loss of consciousness (both resulting from contractions of

the bloodvessels) take place at first, with some spasmodic actions
of the muscles of the eye and face, and then come the cry and the
tonic contraction of the muscles of the limbs and trunk.

The following table will show how the principal phenomena are
generated, one by the other, in the most common form of the vio-
lent and complete epileptic seizures.

CAtJS£S.

1. Excitation of certain parts of the
excito-motory side of the nervous sys-
tem.

2. Contraction of the bloodvessels
of the face.

3. Contraction of the bloodvessels of
the brain proper.

4. Extension of the excitation of the
excito-motory side of the nervous sys-
tem.

5. Tonic contraction of the laryngeal
and of the expiratory muscles.

6. Farther extension of the excitation
of the excito-motory side of the nervous
system.

7. Loss of consciousness, and tonic
contraction of the trunk and limbs.

8. Laryngismus, trachelisraus, and
the fixed state of expiration of the chest.

9. Insufficient oxygenation of the
blood, and many causes of rapid
consumption of the little oxygen ab-
sorbed, and detention of venous blood
in the nervous centres.

10. Asphyxia, and perhaps a mecha-
nical excitation of the base of the en-
cephalon.

EFFECTS,

1. Contraction of bloodvessels of the
brain proper and of the face, and tonic
spasm of some muscles of the eye and
face.

2. Paleness of the face.

3. Loss of consciousness, and accu-
mulation of blood in the base of the
encephalon and in the spinal cord.

4. Tonic contraction of the laryngeal,
the cervical and the expiratory muscles
(laryngismus and trachelismus).

5. Cry.

6. Tonic contractions, extending to
most of the muscles of the trunk and
limbs.

7. Fall.

8. Insufficient oxygenation of the
blood, and general obstacle to the en-
trance of venous blood in the chest, and
special obstacle to its return from the
head and spinal canal.

9. Asphyxia.

10 Clonic convulsions everywhere, con-
tractions of the bowels ; of the bladder ;
of the uterus; erection; ejaculation;
increase of many secretions; efforts at
inspiration.

II. Cessation of the fit; coma or fa-

tigue; headache; sleep.

11. Exhaustion ' of nervous power
generally, and of reflex excitability par-
ticularly, except for respiration. Return
of regular inspirations and expirations.

We have but little to say in explanation of the above table,
which only gives, as we hardly need to remark, a type of a com-
plete seizure.

Writers on epilepsy are unanimous in considering the fall &s due
only to convulsions, while it is certainly, in a measure, the conse-
quence of the loss of consciousness, which alone causes it in some
cases of epileptic vertigo without convulsions.

We do not think that laryngismus in epilepsy has the immense

importance given to it by Dr. Marshall Hall. In the first place,
in persons in whom the reflex excitability is not increased, laryn-
gismus exists IVeqncntly, in whooping cough, in asthma, <fec., with-
out producing epileptic convulsions. In the second place, epileptic
convulsions may exist before laryngismus (Hasse, loco cii., p. 252).
If, instead of saying that laryngismus is the essential cause of con-
vulsions in a lit of epilepsy, we say that asphyxia, whether pro-
duced by laryngismus or by other causes, is the source of a certain
part of the convulsions in the violent and complete fits of epilep-
sy, we shall be much nearer the truth. If we say also that laryn-
gismus is nothing but a spasm of certain muscles — spasm produced
by a reflex action at the same time that there are other spasms in
the bloodvessels of the brain proper, of the face, and also some-
times of the whole surface of the body, and in the muscles of the
head, of the trunk and limbs, and that all these spasms are reflex
contractions, due to the same excitation, we shall be much nearer
the truth than by admitting Dr. Hall's views.

Not only is it wrong to say that convulsions in epilepsy are due
only to laryngismus, but it would be wrong also to say that they
are due only to asphyxia, whatever be its cause. The tonic con-
vulsions, which, according to Dr. Copeland (Diet, of Med., vol. i.,
p. 786), and to Herpin [Loco cit., p. 451,) always exist in the be-
ginning of fits of epilepsy, are not to be attributed to asphyxia,
neither are the convulsive rotary movements which sometimes exist,
and which result principally from the irritation of some parts of the
isthmus of "the encephalon. The tonic convulsions may occur in
almost all the muscles of the body at once, simulating tetanus, or
they come first in the larynx, the neck, the eyes, or the face, and
thence extend to the upper limbs, and at last to the trunk and in-
ferior limbs. These convulsions are mere reflex spasms, as are
the contractions of the bloodvessels. Their duration is only of
some seconds, according to Copeland (Loco cit., p. 786), or a quar-
ter of a minute, according to Herpin ; but they may appear again
during the seizure, as Hasse (p. 252) and Herpin (p. 430) justly
observe, and as I have twice seen. This kind of convulsion, and
also the rotary convulsions, cannot be the result of laryngismus,
because asphyxia does not seem able to produce them. Asphyxia
causes only clonic convulsions, and it seems that we must attribute
to it the universal clonic convulsions of a complete fit of epilepsy.
We have perused the history of many hundred cases of epilepsy,

and we have witnessed eight violent fits in as many epileptics ; and
in all these cases, universal clonic convulsions have begun only af-
ter the appearance of symptoms of asphyxia. In healthy animali
prevented from breathing, clonic convulsions begin in less than half
a minute, and they are universal and very violent in about three
quarters of a minute. General clonic convulsions are produced
sooner, i. e., in twenty to thirty seconds, rarely later in my epilep-
tic animals, when they are absolutely deprived of respiration.

If universal clonic convulsions in epilepsy seem to be due only
to asphyxia, the same thing cannot be said of local clonic convul-
sions, which frequently occur before there is a sufficient degree of
asphyxia to produce them. For more than six years I have, almost
every day, seen in my animals local clonic convulsions following a
tonic spasm of the muscles of the face and neck, long before the
time when a complete deprivation of breathing, had it existed,
could have produced convulsions.

We may conclude — 1st, that neither the general nor local tonic
spasms, nor the local clonic convulsions of epilepsy depend upon
asphyxia, and that therefore they are independent of laryngismus ;
2d, that asphyxia in epilepsy does not usually depend upon laryn-
gismus alone, but that it may result from many other causes, such
as the spasmodic contraction of the muscles of expiration, or from
alternate contractions and relaxations of all the muscles of the chest
and diaphragm. Asphyxia is also partly due to the accumulation of
black blood in the nervous centres, by the obstacle to the return
of venous blood ; and partly also because the energetic actions of
the nervous centres and of the muscles cause a rapid consumption
of oxygen, and charge the blood with carbonic acid. The experi-
ments of Roupell (British Assoc., 1841 ; see Am. Jour, of Med.
Sciences, January, 1842, p. 243) show conclusively the influence of
carbonic acid in causing clonic convulsions, with foam at the mouth,
&c., as in epilepsy.

Asphyxia is not only the cause of the most violent general clonic
convulsions in a fit of epilepsy, but it ia also the usual cause of the
contractions of the bladder, of the bowels, of the uterus, and of the
muscles which produce the erection of the penis and the ejacula-
tion. We admit, however, that all these muscular contractions
may be produced by the same cause to which are due the first tonic
spasms, and that they exist sometimes -whei^ there is no considera-
ble asphyxia, or before the beginning of asphyxia.
11

Wo do not pretend to give here an account of all the phenome-
na of epilepsy; we abstain from speaking of those whicli have
been already well cx))laincd, such as relate to the tongue, and
also to tlie coma so frequent after a very violent fit. We do not
need to say that an immense variety of these phenomena may be
observed in epileptics, and that this variety depends upon the part
first excited in the nervous centres, and upon the degree of the re-
flex excitability and of the reflex force of these centres.

In the beginning of a fit of epilepsy, it sometimes happens that
the heart's action is stopped more or less completely. This stop-
page may be due to two essentially different causes : 1st, the heart
being compressed by the spasmodic contraction of the chest, is me-
chanically rendered more or less completely unable to move, as
may be the case even in a healthy man, according to the interesting
experiments made by Ed. Weber (see Muller's Archiv., 1851, p. 88)
upon himself and upon other persons ; 2d, a reflex action upon
the bloodvessels of the heart may determine their contraction,
and therefore stop at once the movements of this organ, in the
same way that they are stopped sometimes by an emotion, by chlo-
roform, by an irritation of the abdominal sympathetic ox other
nerves, &c. It is well known that the quantity of many secre-
tions, or their quality, may be altered during a fit of epilepsy.
These changes may be due to at least two distinct causes : 1st,
there may be a reflex influence upon the various glands, or upon
their bloodvessels,* as there is a reflex action upon the bloodves-
sels of the face, and very probably of the brain ; 2d, asphyxia is
certainly one of the causes of the changes in secretions during an
epileptic seizure. (See my Experimental Researches applied to
Physiol, and Pathol, 1853, p. 113-114.) As regards saliva,
Lehmann mentions that there is a great flow of it in horses which

» A discussion of priority took place, some time ago, between Dr. H. F. Campbell, of Augusta,
Ga., and Dr. Marshall Hall, concerning the discovery of the existence of reflex secretions. There
is no doubt that Dr. Campbell, who published his first paper in May, 1860, has the priority over
Dr. Hall, but these two able physicians seem not to know that many of ihe German writers bad
long ago gone very far in that field of the reflex secretions. As regards the normal reflex secre-
tions, 1 will point out a short note which I published in 1849 (Compies Reiidus rfc la Soc. dc Piolo-
gie, p. 104, July, 1849, and Gazelle Mid. de Paris, 1849, p. 614), in which, besides Ihe citation of
many facts, I mentioned particularly the production of sweat by a reflex influence. As regards the
pathological reflex secretions, I will direct the reader particularly to the various works of Henle, pub-
lished in 1840, in 1841, and later, 1 will add, that the question is not now whether there arc such
things as reflex secretions, but whether, in the reflex secretions and in the reflex changes of nutri-
tion, there is only an influence upon the muscular elements of the bloodvessels, or if there is some
special electric or nervous influence. (See the treatises by Prof. Ludwig, by Prof. Donders, and
by O. Funke 5 and the great work of Spicss, Palhologishe Physiologie, 1857.)

breathe for a few minutes atmospheric air containing ten per cent,
of carbonic acid {Physiol. Chemistry, English translation, 1853,
vol. ii., p. 177). In the experiments of Roupell, already quoted,
there was much foam at the mouth in dogs, after injections of car-
bonic acid into their veins.

We must say a few words more to explain the relations of epi-
lepsy with sleep, and with the loss of blood. It is well known
that sleep is a very favorable condition for epileptic seizures ; in-
deed, we may say that in many persons who are not, however, epi-
leptic, sleep is a slight attack of epilepsy. The loss of conscious-
ness, of course, exists, and convulsions in many muscles are very
frequent. Whatever be the nature of sleep, it is quite certain that
it is a state of sub-asphyxia, and in this respect also it resembles
epilepsy. It is certain, also, that the circulation in the encepha-
Ion is modified in both epilepsy and sleep. But the kind of trou-
ble in the encephalic circulation, in the beginning of an epileptic
seizure, is not the same as that which takes place during sleep.
In epilepsy, according to the theory we have proposed, there is at
first a contraction of the bloodvessels of the brain proper, and it
is only after a fit has existed a few seconds, or a little longer, that
the spasm of these vessels ceasing, circulation of rather black
blood takes place in them, as during sleep. We have said above
that if the carotid arteries are compressed during a seizure of epi-
lepsy, and if the fit is stopped by it, the reason of this influence is
to be found in an increase of the pre-existing asphyxia. We find
an interesting fact in harmony with this view, in a short paper by
Prof. A. Fleming, of Cork, who states that sleep is easily produc-
ed in persons who are not epileptic, by the compression of the ca-
rotid arteries. [British and Foreign Med.-Chir. Review, April,
1855, p. 404, Am. ed.) The diminution in the supply of arterial
blood produces the same effect as the obstacle to the return of
venous blood, which obstacle is known to cause sleep. When the
carotid arteries do not send blood to the brain proper, circulation
is almost stopped in that part of the encephalon, and the absence
of oxygen produces a sudden paralysis of the brain, and after a
few seconds there is a state of slight asphyxia, marked by sterto-
rous breathing. (Fleming.) If attacks of epilepsy take place
more easily during sleep than during wakefulness, it seems that it
is on account of the slight state of asphyxia existing during sleep.

In cases of epilepsy, or, at least, of convulsions, due to a loss of

blood, or to insufficiency in the quantity of this liquid, there is
also, as a cause of the fits, a state of aspliyxia, due to the fact that
as there is less blood reaching tlie cranio-spinal cavity, the circula-
tion is slower in the nervous centres, and the blood has time to
become charged with carbonic acid and to become an excitant.
Besides, it is certain that when there is not blood enough circulat-
ing in the nervous centres, their reflex excitability becomes in-
creased at the same time that their reflex force diminishes. The
asphyxia due to a diminution of blood seems to cause both the
state of the nervous system favorable to the production of epilep-
tic fits, and the excitation which determines them. In the same
way, the asphyxia due to various causes during a fit of epilepsy
prepares new fits for the future, and actually causes clonic con-
vulsions.

4th. As regards the last question we have to examine, which re-
lates to the effects of attacks of epilepsy, we will only say that
they depend upon three circumstances : 1st, the absence or great
diminution of circulation in the brain proper in the beginning of a
fit of epilepsy; 2d, the circulation of black blood through the ner-
vous centres ; 3d, the pressure upon many parts of the base of the
encephalon and of the spinal cord, by the accumulation of blood in
their vessels.

In consequence of these causes, various disorders of the mind,
of the senses, and of the vital properties of the nervous centres,
are produced. We will not speak of these disorders here, and
will merely refer the reader to the analysis given of most of them
by Dr. Russell Reynolds, in his important researches on the inter-
paroxysmal state of epilepsy. (See Diagnosis of Diseases of the
Brain, (^c, 1855, p. 175, and the London Lancet, 1856.)

§ XV. Treatment of Epilepsy. — Proposing to develop fully this
subject elsewhere, we will merely lay down here a few propo-
sitions.

1. The first thing to be done in a case of epilepsy is to find out
if its origin is peripheric. The state of all the organs must be
inquired into as completely as possible. For some of the means
to be employed to detect the peripheric origin of fits of epilepsy,
we will refer to § XI.

2. If it be ascertained that epilepsy is of peripheric origin, em-
ploy proper means to separate the nervous centres from this ori-

gin, or to remove the cause of the excitation entirely. Leaving
aside what relates to the viscera, the application of ligatures, as
we have shown in § IX., ought to be tried first. Sometimes it
happens, as in a very curious case recorded by Recamier, that the
aura will disappear from a place, and re-appear in another; it will
be well to pursue it thither, and apply ligatures in the new place.

3. If ligatures fail, this is no reason for despairing of other
means having the same object. Tlie nerve animating either the
part of the skin from which originates the aura, or the muscle or
muscles which are the first convulsed, must be laid bare, and sul-
phuric ether thrown upon it. This might, perhaps, be sufficient
to cure the affection; if it is not, then the nerve must be divided.*

4. The amputation of a limb for epilepsy is a barbarous act, the
section of the nerves being all that is necessary.

5. .Sometimes blisters, setons, caustics, &c., in the neighborhood
of a part which is the origin of an aura, may be sufficient to cure,
but these means have not the same efficacy as the application of a
red-hot iron.

6. The best means of treating epilepsy seem to consist in the
application of a series of moxas along the spine, and particularly
the nape of the neck.

7. The nutrition of the nervous centres may be modified, and
thereby epilepsy be cured, principally by the medicines which act
j)n the bloodvessels, such as strychnia, but particularly by those
which determine contractions in these vessels, such as atropia, ergot
of rye, &c.

8. Trepanning, in cases where a blow on the head or some other
circumstance seems to indicate it, ought not to be resorted to until
cauterization and other means of producing a modification of the
conditions of the skin of the head have failed. (See § IX.)

9. Cauterization of the mucous membrane of the larynx, which
has been successful in some cases in which there was considerable
laryngismus, is an excellent means, not only of diminishing or pre-
venting the spasm of the ♦arynx, but as a mode of producing a
modification in the nutrition of the medulla oblongata.

10. As a means of treatment too much neglected, we will point
out the possibility of the transformation of epilepsy into intermit-

* We proposed, many years ago, to employ elher instead of the section of the nerves, in trau-
matic tetanus ; this simple treatment will prove more useful for tetanus than for epilepsy.

tent fever, whicli has been proved by the important facts observed
by Dr. Sclade, by Dumas, &c. The frequent passage of an inter-
mittent fever into epilepsy, and the facts which sliow that the
nerves of the bloodvessels are excited in the nervous centres in
fever and ague (the galvanization of the cervical sympathetic nerve
produces the effects of this fever, viz., cold, soon folloAved by
warmth fxndi perspiration), ^how &\^o \hi)ii there arc great analo-
gies between epilepsy and intermittent fever. So it is as regards
the ef&cacy of ligatures in both diseases. That intermittent fever
is an affection of the nervous system is proved by a curious case
of fracture of the spine, in which the parts paralyzed remained in
their normal state, while the rest of the body had all the pheno-
mena of a paroxysm of fever and ague. (Dr. Knapp, in N. Y.
Jour, of Med., Sept., 1851, p. 199.) From these facts and many
others, we think it would be of the utmost importance to try to
have fever and ague generated in epileptics (See Dumas, in Bib-
liotheque Medicale, vol. xxxi., and Delasiauve, loco cit., p. 378, and
p. 419), as a means of cure of epilepsy.

11. We will merely add, that hygienic means are as .important
as the treatment, and that sleeplessness ought to be as much com-
bated as the disease itself.

As regards the treatment of the fits, we cannot insist too much
upon the prevention or diminution of asphyxia, as it seems certain
that the circulation of black blood in the nervous centres prepares
for the production of future fits. For this object the best means
are, 1st, dashing very cold water on the face ; 2d, the inhalation of
chloroform.

ERRATA.

Page 9, line 8 from the botloin, for " resides " read reside.
•< 11, " 13 "' " " for " B(>u|l " read /?07ici.
" \o, " 3 " " " for"Lafler" road Loefler.
•• 19, " 7 " " " tor " Praxeas" read Praxeos.
" 21, " 1 1 from the lop, for " Dovinetus " tcbA Dminctus.

24, " 17 " " " after " ill llie skill," add /ic/pci-e.
" 29, " 10 from the bottom, for "Pageant" read Pageant.
" 36, " 15 from the top, for " Cazanvielh " read Cazaiivielh.
" 38, " 6 " " " for " Zimmerman " read Zimmermann.

Extrnit ties .trcliivcs g6n«^rnlcN dc Me«1cc-iiio,

niiniero de f^vrier 1856.

RECHERCHES

EXPittlMENTALES

SUR LA PRODUCTION D'UNE AFFECTION CONVULSIVE EPILEPTIFORME ,

A LA SUITE

DE LESIONS DE LA IIOELLE EPlNIEliE;

Par le D*^ E. BRO WIV- SEQU J^lin ,

Laureat de I'Academie des Sciences ,
Vice- President de la Soci6t(; de Biologie ,
Professeur parliculier de Pbysiologie , etc.

Mdmoire In d I'/Zcaddmie des sciences^, Ic 21 Janvier iS'iG.
o-o-^JS^^^o

J'ai irouve , en 1850 (1) , que certaines lesions de la moelle (5pi-
ni^ire, sur des mammif6rcs, sont suivies, au bout de quelques se-
maines, d'une affection convulsive epileptiforme. Depuis cetfe
epoque , j'ai fait un trSs-grand nombre d'experiences h ce sujet , et
je vais exposer sommairement ici les principaux resultats que j'ai
obtenus.

I. J'ai trouve que toutes les lesions que je vais enum^rer sont
capables de prod u ire cetle affection :

1° Section transversale complete ou presque complete d'une
moitie laterale de la moelle 6pini6re ;

2° Section transversale simultanee des cordons poslerieurs, des
comes grises poslerieures et d'une partie des cordons lat^raux ;

3° Section transversale des cordons posterieurs , ou des cordons
lat^raux, ou des cordons anterieurs seuls ;

(I) Voyez Comp[es reiulas dc la Socieldde biologie, t. 11, p. 105, 169; 1810.

4" Section Iransvcrsalc complf;lc de la moelle ^pinifcrc ;
6" Simple piqfirc dc la moelle epinifire.

Dc toules CCS lesions , celles qui paraisscnt avoir le plus d'effica-
cite pour produire la maladie convulsive que j'ai i'tudiee sont la
premiere el la deuxifcme. La premiere surlout , a savoir la section
d'une moilie lat^rale de la moelle, produit constamment ctWt ma-
ladie chez les aniraaux qui survivent plus de trois h quatre seraaioes
\x I'operation; en outre, chez ces animaux, I'intensit^ et la fre-
quence des acc6s (5pilepliforraes sont beaucoup plus grandes que
cliez ceux que j'al soumis & d'autres lesions de la moelle 6pi-
niiire.

AprSs la section des cordons posterieurs , ou des lalcraux , ou des
anterieurs , et surlout apres une simple piqCire de la moelle, celte
affection convulsive survienl rarement.

II. De toute la partie de la moelle epinifire etcndue entre son ex-
tremite caudale et le milieu dc la region dorsale, c'est la portion
comprise entre la sepli^me ou la huitiferae verlfebre dorsale et la
troisi6rae lombaire dont les lesions produisent le plus souvenl cette
maladie convulsive. En arrifere de cetle portion de la moelle , les le-
sions paraisscnt etre de moins en moins capables de produire cette
affection , a raesure qu'elles sont iaites plus pres de Texlremite
caudale de ce centre nerveux.

Quant a la portion cervicale de la moelle epiniere, je nai vu
qu'une fois, apr^;s I'avoir lesee, survenir cette affection; mais la
mort arrive presque toujours trop vite aprfes la lesion de celte
partie de la moelle pour que la maladie ait le temps de se montrer.
De ce que je n'ai vu celte affection qu'une fois dans de telles cir-
constances , il ne faudrait done pas conclurc que la moelle cervicale
est moins capable de la produire que la moelle dorsale ou la moelle
lombaire.

III. L'cpoquc d'apparitiou de celte affection est a peu prts la
mCme dans la plupart des cas ; c est dans la troisifeme scmaine apres
la lesion que les convulsions se montrent ordinairemenl pour la pre-
miere fois. Ccpendanl .fai vu , mais tr^s-raremcnt, les convulsions
survenir vers la fin dc la premiere semaine ; il est uu peu moins rare
(le les voir commenccr dans la seconde semaine.

— 3 -

IV. Lcs pai'lics du corps oCi se montrcnt les convulsions varicnl
siiivaut le siege de la lesion. Lorsque celle-ci se trouvc au niveau
des dernifircs verlfcbi'cs dorsales ou des premieres lorabaires , et
qu'elle consiste dans la section d une raoitic lalerale de la moeile
(ipinifere, les convulsions ont lieu dans toutes les parlies du corps,
a I'exception du membre posterieur du cote oil la section a ele faile.
Si la lesion consiste dans la section des deux cordons posterieurs ou
dans cellc de ces cordons, et d'une portion des cordons lateraux
avec une petite partie de la substance grise, les convulsions ont
lieu dans la t6te, le trouc, etles qualre raembres. U en est de m6me
apres la piqCire d'une partie quelconque de la mo,elle ; raais , aprfes
la section des cordons lateraux ou des cordons anterieurs au ni-
veau des derniferes vertSbres dorsales , les resultats sont diffcrents.
11 y a souvent alors des convulsions isolees dans le train anterieur,
et quelquefois il en existe, isolement aussi, dans le train posterieur ;
dans quelques cas, j'ai vu des convulsions commencees dans Tun
des deux trains se propager k Tautre. Apr6s une section transver-
sale complete de la moelle epinifere , au niveau des derniSres ver-
t^bres dorsales ou des premieres lorabaires, les convulsions sont
limitees au train anterieur ; dans le train posterieur, il n'y a gufere
que des roideurs ou de la contracture.

V. Les convulsions ont lieu quelquefois sans excitation exte-
rieure ; mais on peul , en general , les provoquer tres-ais^raent par
certaines excitations. J'ai constate que loute irritation d'une partie
quelconque du corps de Tanimal, a I'exception dc la face, ne pro-
duit pas d'acc6s ; tandis qu'au conlraire , en general , toute irrita-
tion un peu vive de la face, et surtout de la partie animee par le
nerf sous-orbitaire , produit un acces. Tanlot c'est une moitie seule
de la Face qui a celte faculte de causer des convulsions quand on
I'irrite , Iant6t ce sont les deux moities. Lorsque la lesion de la
raoelle est limitee a I'une de ses moities laterales, c'cst la moitie
de la face du c6te correspondantqui , seule, a la puissance d'exciter
des convulsions. Quand ki lesion existe sur les deux moities late-
rales de la moelle , les deux moiiies de la face ont celte puissance ;
le pincement de la peau de la face ou I'irritation de cette partie ,
soil par une brCilure, soit par le galvanisrae, pcuvent egaleraent
causer des convulsions. Ouelquefois, chez des aniraaux ayant a un
iri's-haut degrc I'affectiou convulsive qui rcsulle d'une lesion dc

— 4 —

la moelle (ipinifcre , il m'a sulfi dc touclier la peau dc la lace ou
m6me dc soufflcr sur elle pour produire un accfes,

Le pouvoir que possfcdc le ncrf trijumeau de causer dcs convul-
sions nc vient pas seuleraent dc ce que ce nerf est lr6s-sensible el
de ce que Ton produit une vivc douleur en I'irritant; car, chcz
!es animaux sur lesquels on a coup6 les cordons posterieurs a la
partic superieure de la region lombaire , les deux membres pos-
terieurs sont , ainsi que je I'ai fait connaitre ailleurs , dans un dtat
d'hypereslhesie considerable , et pourtant on peut les pincer, les
brfiler, les galvaniser, sans causer d'acc^s. II en est dc m6me chez
les animaux ayant eu une section d'une raoitie laterale de la moelle
dpinifere ; on peut irriter trfes-vivement le membre postdrieur du
c6te de la section, sans causer d'acc^s, bien que ce membre soil
dans un etat d'hyperesthesie trfes-notable.

VI. On peut produire I'accfes par un autre precede que I'irritn-
tion de la face : il suffit d'empficher I'animal de respirer pendant
un temps tr^;s-court. On sail que chez les animaux a I'^tat desante,
de mf^me que chez Thomme, une asphyxie complete produit des
convulsions au bout d'une minute et demie ou deux minutes. Chez
les animaux atteints de I'affection convulsive dont je m'occupe,
I'asphyxie produit I'accfes au bout de dix h trente secondes. Get acc^is
diff^re essentiellement des convulsions qui ont lieu chez les ani-
maux sains qu'on asphyxie , en ce qu'il continue aprfes qu'on a laisse
I'animal libre de respirer; tandis que, chez les animaux sains, les
convulsions cessent presque aussit6t aprfes qu'on leur a permis de
respirer.

VII. Les premiers acc6s que Ton produit a la suite d'une lesion
de la moelle epinifere consistent seulement dans des convulsions des
muscles de la face et du globe oculaire; mais I'affection convulsive
gagnedu terrain et, apr^s quelques jours, les muscles du cou se
convulsent aussi. Enfin la maladie s'etend h toutes les parties du
corps qu'elle peut atteindre , et Ton observe alors , dans I'accfes , les
pMnomfenes suivants : les muscles de la face , du globe oculaire, des
mkhoires, de lalangue, etceux du cou, sc conlraclent et se rcK^chcnt
alternalivement ; la tete est liree tanl6t h gauche, lant6t a droite;
la respiration s'arr<itc par suite d'un spasme soil des muscles du

thorax, soil de ceux du larynx; cnfia les muscles dii tronc entrent
en convulsion, ainsi que ceux des membres. (Juand la lesion de la
raoelle consiste dans une section d'une de ses moities laterales, le
membre posterieur du c6te oppose a cette section se flechit et s'e-
tend alternativement et rapidement, pendant quele tronc de I'ani-
raal est courb6 en arc par la contraction des muscles du c6te oQ le
membre posterieur s'agite. Apr6s un temps variable, les convulsions
cessent tout h coup, et I'animal tombe haletant sur le c6t6 ; il se
relive cependant aprfis une ou deux minutes, et il essaye de mar-
cher; mais, le plus souvent alors, il survient de nouvelles convul-
sions moins fortes et moins durables que les premieres.

Quand les accfes sont tr6s-violents , il y a souvent emission d'li-
rine et de mati^res fecales ; j'ai vu quelquefois I'^rection de la verge
ct deux fois I'^jaculation.

VIII. Quelle est la nature de cette affection convulsive? Les
pheuomfenes que je viens de decrire la rapprochcnt de I'epilepsie
bien plus que de toute autre maladie convulsive. Elle parait ce-
pendant , a certains egards, differer de I'epilepsie : ainsi elle semble
quelquefois ne pas produire une perte complete de connaissance ,
car les animaux crient pendant I'accSs quand on les pince. Mais,
comme les cris, ainsi que je I'ai montre dans un memoire lu a I'A-
cad^mie en 1849 (Comptes rendus, t. XXIX, p. 672), peuvent
ne pas Hre des signes de douleur, et n'^tre que des phenomfenes
reflexes, il est possible que ces animaux , malgre leurs cris, soient
completement prives de connaissance; s'il en est ainsi , il n'y a pas
de difference capitale entre Faffection convulsive qui existe chez
ces animaux et Tepilepsie telle qu'on I'observe chez I'homme.

Ce qui est surtout remarquable dans I'affection epileptiforme
que je produis sur les mammifferes, c'est que les accfes de convul-
sion peuvent 6tre occasionnes par action reflexe, quand une excita-
tion est portee sur les ramifications du nerf trijumeau. II y a ainsi,
entre ces accfes et les convulsions chez les enfants par suite de
I'irritation des nerfs dentaires , une ressemblance tr{;s-grande.

IX. Norabre d'auteurs, parmi lesquels surtout Esquirol, Portal,
M. Calraeil, MM. Bouchet et Cazauvielh, out signale la coexistence
dc Tepilepsic et d'altcrations de la raoelle epini^re. Georget et

— 6 -

d'autres palhologistes u'onl voulu voir dans ces cas que dc simples
coiucidcnces. Lcs tails que j'ai observes sur les aniiiiaux, en deinon-
trant direclement que les alleralions de la inoelle epiiiifcre peuvenl
(ilre la eausc premitre d'uue aHeclion epilepliforrnc , reudent ex-
IrCmeraeut probable que Tcipilepsic, dans nombre des cas nien-
liouues par les auleurs que j'ai cites, dependait de laUeralioa de la
moelle que I'aulopsie a fait voir.

X. Les animaux alteinis d'une affection convulsive , a la suite
d'unc lesion de la moelle, pcuveiit vivre lonjjtemps sans trouble
apparent de leur sanle generale; j'en ai garde pendant pres dc
deux ans.

L'affection convulsive, une fois declaree, ne disparait sponlanc-
raent que dans de (rfes-rares circonstances. A peine ai-je vu Irois
ou qualre individus guerir spontaneraent.

XI. J'ai constate trfes-souvent que le nombre des accfes augmente
considerablement chez les animaux nourris abondamment et ren-
ferraes dans des caisses oil ils avaient Ir6s-peu de place pour se
mouvoir. Dans ces conditions, plusieurs de ces animaux ont cu
spontaneraent jusqu'Si 40 ou 50 accfes par jour. Les m6mes ani-
maux, soumis a un tout autre regime , et laisses libres dans une
vaste chambre, ne paraissaient plus, aubout de quelques scmaines,
capables d'avoir d'acc6s spontanes,et il elait difficile de leur en
donner par de vives excitations. II m'a semble que ce traiteraent
par la di6te a suffi pour guerir quelques-uns d'entre eux.

XII. A I'autopsie des animaux atteints de cette affection con-
vulsive, j'ai trouve, en outre de la lesion de la moelle que j'avais
produite, un etat de congestion de la base de rencephale et du
ganglion de Gasser, des deux c6tes quand les deux coles de la
moelle avaient et6 leses, et seulement du cote de la lesion quand
clle n'existait que sur une moitie laterale de la moelle epinifere.

XIIL Dans un second meraoire, je communiquerai ii I'Academie
les r^sultats des recherches que j'ai faites sur le Irailcment dc cclie
affection ^pileptiforme, resultatsqui m'ont conduit a employer sur
rhommo un mode de Iraitemcnt dc I'epilcpsie qui deja parait avoir

gueri quclqucs maladcs. Je me bornerai fi dire que la cauterisalion
dcs ramifications dii nerf vague dans Ics muqueuses du larynx c(
du pharynx a paru guerir un assez grand nombre d'animaux sur
lesquels j'avais produit I'affecUon epilcptiforme que j'ai decrile ;
des rccherches plus recentes m'ont appris que loule irritation vio-
Icnte des nerfs sensitifs encfphaliques ou des nerfs cervicaux
peut etre suivic du m6me effet.

Conclusions.

Des fails rapportes dans ce memoire , je crois pouvoir tircr les
conclusions suivantes :

r Des lesions vari(5es de la moelle epiniire peuvcnt produire
chez les mammifferes una affection convulsive ayant beaucoup
d'analogie avec I'^pilepsie ; il semble consequemment que chez
rhomme, dans les cas nombreux oCi Ton a rencontre dcs altera-
tions de la moelle epinif;re chez des 6pilcptiques, I'epilepsic a dA
avoir quelquefois sa cause premiere dans ces alterations.

2" Des lesions de la moelle epinifcre peuvcnt produire un chan-
gement tel dans la vilalite du nerf trijumeau ou de la partie de
i'encephale ou ce nerf aboulit, que Texcilalion des ramificalions de
ce nerf la la face occasionne des convulsions; de plus, la moitie
droite de la moelle a cette influence sur rcnccphalc ou sur le nerf
trijumeau du cAle droit, et la moilie gauche de la moelle sur I'en-
cephale ou sur le nerf trijumeau du cote gauche.

Tarie. — Rit;>oi:?;; Imprimr iir do lal-'acnllO dc "ICdrcinn, nir MonFi'.ur-lo-rrinrt> . 31.

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Full text of "Researches on epilepsy [electronic resource] : its artificial production in animals, and its etiology, nature and treatment in man : first part of a new series of experimental and clinical researches applied to physiology and pathology"

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